Healthcare Provider Details

I. General information

NPI: 1558904813
Provider Name (Legal Business Name): JOSEPH RICHARD GAGNON JR. CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2019
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 DUPORTAIL RD FL 2
CHESTERBROOK PA
19087-5575
US

IV. Provider business mailing address

219 FORGE RD
COLLEGEVILLE PA
19426-1707
US

V. Phone/Fax

Practice location:
  • Phone: 856-699-1710
  • Fax: 856-249-9109
Mailing address:
  • Phone: 267-718-0498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN631678
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP021305
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: