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General NPI Number Information
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NPI Number | 1700244944
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Entity Type | Individual
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Provider Name | NICK FAGER LMHC
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Gender | Male
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Dates
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Enumeration Date | 02/03/2016
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Last Update Date | 01/09/2018
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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 | 84 HORATIO ST APT 4C
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City | NEW YORK
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State | NY
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Zip | 10014-1561
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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 |
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Name |
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Credential |
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Telephone |
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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 |
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License Number State |
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