Individual
BENJAMIN JACOB FAGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
600 LAKE HOLLINGSWORTH DR, LAKELAND, FL 33803-2364
(844) 854-1116
Mailing address
1500 S DOUGLAS RD STE 230, CORAL GABLES, FL 33134-4108
(844) 244-1818
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
06/26/2019
Last updated
10/31/2023
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