Healthcare Provider Details

I. General information

NPI: 1851315451
Provider Name (Legal Business Name): STEPHANIE FAGIN-JONES PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 W END AVE 1C
NEW YORK NY
10025-3533
US

IV. Provider business mailing address

80 CRANBERRY ST 5C
BROOKLYN NY
11201-1726
US

V. Phone/Fax

Practice location:
  • Phone: 212-851-8100
  • Fax: 212-932-0964
Mailing address:
  • Phone: 917-225-2497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number16180
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: