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Organization
GLENN S. FAGEN PHD INC
Active
Organization
GLENN S. FAGEN PHD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLENN SCOTT FAGEN PHD (PRESIDENT)
(413) 584-8339
Entity
Organization
Contact information
Practice address
100 KING ST, SUITE 303, NORTHAMPTON, MA 01060-3243
(413) 584-8339
(413) 584-8339
Mailing address
100 KING ST, SUITE 303, NORTHAMPTON, MA 01060-3243
(413) 584-8339
(413) 584-8807
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
6793
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0524484
—
MA
01
—
W05440
BLUE CROSS AND BLUE SHIELD
MA
Enumeration date
12/30/2010
Last updated
04/26/2011
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