MS. ALICIA MARY FAGAN LCSW NPI 1629157615

NPI Information

NPI: 1629157615
Provider Name: MS. ALICIA MARY FAGAN, LCSW
Classification: Counselor - 101YA0400X
Entity Type: Individual

Specialization: Addiction (Substance Use Disorder)

PECOS Registration: Yes

Address:
51 NORTH MAIN STREET
STE 2C
SOUTHINGTON, CT
ZIP 06489
Phone: (860) 621-2280
Get Directions

MS. Alicia Mary Fagan, LCSW is an addiction (substance use disorder) counselor in Southington, CT with 47 years of experience. MS. Alicia Mary Fagan, LCSW NPI is 1629157615. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

51 NORTH MAIN STREET
STE 2C
SOUTHINGTON, CT
ZIP 06489
Phone: (860) 621-2280
Fax: (860) 628-0219

The NPI 1629157615 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment.

The enumeration date for this NPI number is 11/2/2006 and was last updated on 1/6/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1041C0700X	Social Worker	Clinical	000618	CONNECTICUT	No
2	101YA0400X	Counselor	Addiction (Substance Use Disorder)	000422	CONNECTICUT	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	800000473	MEDICARE ID-TYPE UNSPECIFIED	CONNECTICUT
2	004149531	MEDICAID	CONNECTICUT

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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