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General NPI Number Information
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NPI Number | 1891085767
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Entity Type | Individual
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Provider Name | JAMES ADRIAN FOGARTY ED.D.
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Gender | Male
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Dates
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Enumeration Date | 04/13/2011
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Last Update Date | 04/27/2016
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Provider Practice Location Address
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Address Line | 122 S. PRAIRIE ST. SUITE A
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City | ROCKTON
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State | IL
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Zip | 61072
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Country | US
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Telephone | 815-624-8383
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Fax | 815-624-8383
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Provider Business Mailing Address
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Address Line | 122 S. PRAIRIE ST SUITE A
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City | ROCKTON
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State | IL
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Zip | 61072
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Country | US
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Telephone | 815-624-8383
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Fax | 815-624-8383
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.003659
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071-003-659
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License Number State | IL
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