Individual
CARRIE FAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
255 EXECUTIVE DR, SUITE LL108, PLAINVIEW, NY 11803-1718
(516) 576-2040
Mailing address
2436 6TH AVE, EAST MEADOW, NY 11554-3235
(516) 647-5280
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
944199151
NY
Other
Enumeration date
07/13/2015
Last updated
07/13/2015
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