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General NPI Number Information
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NPI Number | 1164910477
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Entity Type | Organization
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Legal Business Name | NICHOLAS FAGER LICENSED MENTAL HEALTH COUNSELOR PLLC
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Dates
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Enumeration Date | 04/23/2018
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Last Update Date | 04/23/2018
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Provider Practice Location Address
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Address Line | 225 BROADWAY STE 3009
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City | NEW YORK
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State | NY
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Zip | 10007-3071
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Country | US
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Telephone | 203-253-6602
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Fax |
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Provider Business Mailing Address
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Address Line | 225 BROADWAY STE 3009
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City | NEW YORK
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State | NY
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Zip | 10007-3071
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Country | US
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Telephone | 203-253-6602
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. NICHOLAS FAGER
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Credential | LMHC
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Telephone | 203-253-6602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 008313
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 085005-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 008364
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License Number State | NY
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