MEDICARE: NANCY S FAGAN 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
1	1041C0700X	Clinical Social Worker	CW013092	PA

General Provider Information

NPI Number	:	1790375566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY S FAGAN LCSW

Provider Business Mailing Address
First Line	:	1312 HIGHLAND AVE
Second Line	:
City	:	FORT WASHINGTON
State	:	PA
Zip	:	19034-1608
Country	:	US
Telephone Number	:	215-805-6349
Fax Number	:

Provider Business Practice Location Address
First Line	:	7500 GERMANTOWN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119-1600
Country	:	US
Telephone Number	:	215-753-8111
Fax Number	:

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

Provider Enumeration Date	:	01/25/2021
Last Update Date	:	01/25/2021

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