Glenn S. Fagen PHD Inc

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

6793 Issued in MA

Legal business name

GLENN S. FAGEN PHD INC

Practice address

100 King St
Suite 303
Northampton, MA 01060-3243

Phone

(413) 584-8339

Fax

(413) 584-8339

NPI assigned

Dec 30, 2010

Last updated

Apr 26, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Glenn Scott Fagen, PHDNPI 1932134947

Title

President

Phone

(413) 584-8339

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Glenn Scott Fagen, PHD

  • Psychologist
  • Northampton, MA
  • NPI 1932134947
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1293667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303776000000",
    "number": "1518261874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 KING ST",
            "address_2": "SUITE 303",
            "city": "NORTHAMPTON",
            "state": "MA",
            "postal_code": "010603243",
            "telephone_number": "413-584-8339",
            "fax_number": "413-584-8807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 KING ST",
            "address_2": "SUITE 303",
            "city": "NORTHAMPTON",
            "state": "MA",
            "postal_code": "010603243",
            "telephone_number": "413-584-8339",
            "fax_number": "413-584-8339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENN S. FAGEN PHD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-30",
        "last_updated": "2011-04-26",
        "status": "A",
        "authorized_official_last_name": "FAGEN",
        "authorized_official_first_name": "GLENN",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "413-584-8339",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "MA",
            "license": "6793",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0524484",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS AND BLUE SHIELD",
            "identifier": "W05440",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Marie Giroux
• Paul Giza
• Lisa K. Glantz, MD
• Amy Gleason, RN
• Natalia Glebova, MSW
• Sandy G. Glynn, LICSW
• Alice Gmyrek, RN
• Annemarie Gockel, M.S.W.,PH.D.
• Daniel Richard Godbout, DC
• Julia L Godfrey, PA

• Mental Health Clinic/Center (Including Community Mental Health Center) in Northampton, MA
• Providers in Northampton, MA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.