# PSYCHIATRIC EDGE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659135986
- **Authorized official:** JOSEPH RICHARD GAGNON JR. CRNP,PMHNP-BC, MSN (OWNER)
- **Authorized official phone:** (856) 699-1719

## Contact information

- **Practice address:** 851 DUPORTAIL RD FL 2, CHESTERBROOK, PA 19087-5575
- **Practice address phone:** (856) 699-1719
- **Practice address fax:** (856) 249-9109
- **Mailing address:** 851 DUPORTAIL RD FL 2, CHESTERBROOK, PA 19087-5575
- **Mailing address phone:** (856) 699-1719
- **Mailing address fax:** (856) 249-9109

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0850X | Adult Mental Health Clinic/Center | — | NULL | — |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 02/07/2024
- **Last updated:** 11/24/2025