Individual
MS. ALICIA MARY FAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
51 NORTH MAIN STREET, STE 2C, SOUTHINGTON, CT 06489
(860) 621-2280
(860) 628-0219
Mailing address
51 NORTH MAIN STREET, STE 2C, SOUTHINGTON, CT 06489
(860) 621-2280
(860) 628-0219
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
000422
CT
1041C0700X
Clinical Social Worker
000618
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004149531
—
CT
Enumeration date
11/02/2006
Last updated
01/06/2012
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