Individual
DR. MARC FAGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
4101 N RAVENSWOOD AVE., CHICAGO, IL 60613
(773) 572-5402
Mailing address
1335 DEERFIELD RD, DEERFIELD, IL 60015
(847) 651-2493
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
071.006654
IL
Other
Enumeration date
01/25/2017
Last updated
01/25/2017
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