MS. ALICIA MARY FAGAN (NPI# 1629157615) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629157615 |
| Entity Type | Individual |
| Full Name | MS. ALICIA MARY FAGAN |
| Credential | LCSW |
| Practice Address |
51 North Main Street Ste 2c Southington CT 06489 |
| Practice Telephone | 8606212280 |
| Practice Fax Number | 8606280219 |
| Mailing Telephone | 8606212280 |
| Mailing Fax Number | 8606280219 |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2012-01-06 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
000422 | CT | Behavioral Health & Social Service Providers |
| N | 1041C0700X |
Social Worker Specialization: Clinical |
000618 | CT | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | 004149531 | 05 |
| Street Address |
51 NORTH MAIN STREET STE 2C |
| City | SOUTHINGTON |
| State | CT |
| Zip Code | 06489 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467087783 | Shankar Panwar | Counselor | K 11, 1783 Meriden Waterbury Tpke, Southington, CT 06489 | 2020-03-06 |
| 1235771056 | Kathleen Rebecca Mckinney | Music Therapist | 196 Queen St., Southington, CT 06489 | 2019-10-14 |
| 1336700103 | Julie Amanda Nichols | Behavioral Analyst | 1842 Meriden-waterbury Turnpike, Southington, CT 06489 | 2019-06-24 |
| 1396238960 | Kriston Ronalter | Physician Assistant | 775 Queen Street, Southington, CT 06489 | 2018-06-08 |
| 1366933582 | Cj's Counseling, LLC | Counselor | 17 Meriden Ave Ste 1a, Southington, CT 06489 | 2018-05-23 |
| 1104329887 | Koby Douglas Fowler | Chiropractor | 1095 West St Unit 1, Southington, CT 06489 | 2018-03-09 |
| 1447763131 | Samreen, LLC | Clinic/Center | 775 Queen St, Suite 2, Southington, CT 06489 | 2017-11-16 |
| 1902320724 | Michael Petit | Physical Therapist | 98 Main Street, 202, Southington, CT 06489 | 2017-08-02 |
| 1457712127 | Leslie Mclaughlin | Speech-Language Pathologist | 400 Flanders Rd, Southington, CT 06489 | 2016-03-09 |
| 1306219159 | Breanne Schnepf-hanbury | Counselor | 26 N Main St Ste 2b, Southington, CT 06489 | 2015-11-02 |
| Find all providers in zip 06489 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467087783 | Shankar Panwar | Counselor | K 11, 1783 Meriden Waterbury Tpke, Southington, CT 06489 | 2020-03-06 |
| 1093824294 | Audrey L Bennett | Counselor | 100 Queen Street, Audrey Bennett Weave Your Life LLC., Southington, CT 06489-2052 | 2006-08-30 |
| 1851927248 | Clufoir Counseling and Social Services LLC | Counselor | 1783 Meriden Waterbury Tpke, Unit # 11, Southington, CT 06489-0268 | 2020-03-17 |
| 1225443856 | Kevin Lardner | Counselor | 1783 Meriden Waterbury Turnpike, Suite K 11, Southington, CT 06489-0268 | 2014-06-23 |
| 1659606838 | Albert Young | Counselor | 26 N Main St, Suite 2a, Southington, CT 06489-2572 | 2009-10-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235737735 | Southbury Adolescent and Young Adult Counseling Center LLC | Counselor | 385 Main St S Ste 217, Southbury, CT 06488-4246 | 2020-10-15 |
| 1821696675 | Bunny Catherina Rodriguez | Counselor | 60 Lake Rd, North Branford, CT 06471-1252 | 2020-10-14 |
| 1780282681 | Marcie Rivera | Counselor | 47 Coit St, New London, CT 06320-5924 | 2020-10-13 |
| 1003428897 | Francesca Nicole Porter | Counselor | 39 Burnham St, Enfield, CT 06082-6144 | 2020-08-21 |
| 1952912271 | Patience Ashong | Counselor | 191 High Ridge Dr, Bridgeport, CT 06606-4965 | 2020-08-11 |
| 1366051468 | Evan Hunter Jr. | Counselor | 53 Hawthorne Ave, Waterbury, CT 06708-4614 | 2020-07-24 |
| 1710505284 | Alfred Levi Greenleaf Jr. | Counselor | 51 Maheu St, Bristol, CT 06010-3051 | 2020-07-10 |
| 1316560089 | Sean Thomas Marcil | Counselor | 1776 Meriden Rd Rear Unitb, Wolcott, CT 06716-3341 | 2020-05-28 |
| 1396365706 | Angela M Massiello | Counselor | 192 Maple Ave, Uncasville, CT 06382-2018 | 2020-04-26 |
| 1750901005 | A Better Day Counseling Center LLC | Counselor | 403 New Litchfield St, Torrington, CT 06790-6640 | 2020-04-16 |
| Find all providers with the same taxonomy | ||||
| City | SOUTHINGTON |
| Zip Code | 06489 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.