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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