C Gavriel Fagin, PHD, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

078842-1 Issued in NY

Practice address

420 Central Ave
Cedarhurst, NY 11516-1000

Phone

(917) 257-8626

NPI assigned

Mar 22, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703203200000",
    "number": "1073572681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 PINE ST",
            "city": "WOODMERE",
            "state": "NY",
            "postal_code": "115982627",
            "telephone_number": "917-257-8626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 CENTRAL AVE",
            "city": "CEDARHURST",
            "state": "NY",
            "postal_code": "115161000",
            "telephone_number": "917-257-8626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGIN",
        "first_name": "C",
        "middle_name": "GAVRIEL",
        "name_prefix": "Dr.",
        "credential": "PHD, LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-22",
        "last_updated": "2023-12-22",
        "certification_date": "2023-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "078842-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Cedarhurst, NY
• Providers in Cedarhurst, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.