Kevin Charles Fagan, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

ISW01620 Issued in RI

Practice address

931 Jefferson Blvd.
Suite 2009
Warwick, RI 02886

Phone

(401) 921-5400

Fax

(401) 921-5402

NPI assigned

Jan 26, 2007

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)

Enrolled

State licenses

Practice roles

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.

• Child & Family Services of Newport County

  • Clinical Social Worker
  • Newport, RI
  • NPI 1194940437
  NPD (past)
• Child and Family Services of Newport County

  • Clinic/Center
  • Middletown, RI
  • NPI 1063425189
  NPD (past)
• Psychologists at Jefferson Gateway, LLC

  • Clinical Psychologist
  • Warwick, RI
  • NPI 1952622953
  NPD (past)

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308700800000",
    "number": "1396891719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "931 JEFFERSON BLVD.",
            "address_2": "SUITE 2009",
            "city": "WARWICK",
            "state": "RI",
            "postal_code": "02886",
            "telephone_number": "401-921-5400",
            "fax_number": "401-921-5402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "931 JEFFERSON BLVD.",
            "address_2": "SUITE 2009",
            "city": "WARWICK",
            "state": "RI",
            "postal_code": "02886",
            "telephone_number": "401-921-5400",
            "fax_number": "401-921-5402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGAN",
        "first_name": "KEVIN",
        "middle_name": "CHARLES",
        "name_prefix": "Mr.",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-26",
        "last_updated": "2011-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "RI",
            "license": "ISW01620",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Mark Eves, DMD, MS
• Gerald Exil, MD
• Alan Ezovski, LICSW
• Facial and Oral Surgery
• Victoria Ann Fackos, LICSW, LCDCS
• Faine SC
• Ana A Faiola
• Dariene Marie Falcon Figueroa
• Allison Ann Falkenberry, MSW
• Donna Fallon, NP

• Clinical Social Worker in Warwick, RI
• Providers in Warwick, RI by specialty
• Clinical Social Worker in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2011; 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.