MEDICARE: EMILY V FAGEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1194661314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY V FAGEL

Provider Business Mailing Address
First Line	:	400 KOSCIUSZKO ST APT 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-2006
Country	:	US
Telephone Number	:	847-525-3132
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 WEST 135TH STREET
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10031
Country	:	US
Telephone Number	:	212-694-9200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2026
Last Update Date	:	04/28/2026

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Directions to “ EMILY V FAGEL ” Practice Location

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