Healthcare Provider Details

I. General information

NPI: 1932945177
Provider Name (Legal Business Name): JULIA FAGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

352 7TH AVE RM 701
NEW YORK NY
10001-5885
US

IV. Provider business mailing address

672 FRANKLIN AVE APT 3
BROOKLYN NY
11238-3880
US

V. Phone/Fax

Practice location:
  • Phone: 813-602-2232
  • Fax:
Mailing address:
  • Phone: 718-764-3131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: