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NPI Code Detail

MEDICARE: MR. JAMES M GAGNON PHD, MSW, LCSW

MEDICARE: MR. JAMES M GAGNON PHD, MSW, LCSW
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
1103T00000XPsychologistSW4770FL

General Provider Information

NPI Number : 1780684274
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAMES M GAGNON PHD, MSW, LCSW
Provider Business Mailing Address
First Line : 220 OFFICE PLZ
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32301-2808
Country : US
Telephone Number : 850-877-0205
Fax Number : 850-877-1129
Provider Business Practice Location Address
First Line : 220 OFFICE PLZ
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32301-2808
Country : US
Telephone Number : 850-877-0205
Fax Number : 850-877-1129
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2005
Last Update Date : 02/25/2019

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