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General NPI Number Information
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NPI Number | 1790375566
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Entity Type | Individual
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Provider Name | NANCY S FAGAN LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/25/2021
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Last Update Date | 01/25/2021
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Provider Practice Location Address
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Address Line | 7500 GERMANTOWN AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19119-1600
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Country | US
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Telephone | 215-753-8111
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Fax |
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Provider Business Mailing Address
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Address Line | 1312 HIGHLAND AVE
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City | FORT WASHINGTON
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State | PA
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Zip | 19034-1608
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Country | US
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Telephone | 215-805-6349
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW013092
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License Number State | PA
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