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Individual
DR. JEFFREY FORTGANG
Active
Individual
DR. JEFFREY FORTGANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1066
MA
103TC0700X
Clinical Psychologist
2822
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014616
VALUE OPTIONS
—
05
—
0526436
—
MA
01
—
151539
MAGELLAN
—
01
—
4338079
AETNA
—
01
—
720563
TUFTS HEALTH PLAN
—
01
—
W03000
BLUE CROSS BLUE SHIELD
MA
Enumeration date
08/01/2006
Last updated
09/11/2025
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