Active NPI
Douglas Brian Fagen, PHD
- Clinical Psychologist
- Washington, DC
National Provider Identifier
1154777803
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1000067
- Practice address
- 4759 Reservoir Rd NW
Washington, DC 20007-1921 - Phone
- (202) 944-3071
- Fax
- (202) 454-2292
- NPI assigned
- May 12, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1000067 | DC | Primary |
Addresses
Primary practice location
4759 Reservoir Rd NW
Washington, DC 20007-1921
Mailing address
4759 Reservoir Rd NW
Washington, DC 20007-1921
Phone (202) 944-3071
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1000067 | DC | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Lab School of Washington | Clinical | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Psychologist
- Washington, DC
- NPI 1770710014
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1463011200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1463011200000",
"number": "1154777803",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4759 RESERVOIR RD NW",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200071921",
"telephone_number": "202-944-3071",
"fax_number": "202-454-2292"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4759 RESERVOIR RD NW",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200071921",
"telephone_number": "202-944-3071",
"fax_number": "202-454-2292"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAGEN",
"first_name": "DOUGLAS",
"middle_name": "BRIAN",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-05-12",
"last_updated": "2016-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "DC",
"license": "1000067",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.