Active NPI
Stephanie A Fagan, LICSW
- Clinical Social Worker
- Dayville, CT
National Provider Identifier
1679839997
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 1237
- Practice address
- 1006 N Main Street
Dayville, CT 06241-2170 - Phone
- (860) 774-2020
- Fax
- (860) 779-5437
- NPI assigned
- Apr 11, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LC50081357 | DC | |
| Clinical Social Worker | 1041C0700X | 1237 | CT | Primary |
Addresses
Primary practice location
1006 N Main Street
Dayville, CT 06241-2170
Mailing address
4115 Wisconsin Ave NW
Apt. 501
Washington, DC 20016
Phone (347) 254-4668
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004040564 | Medicaid | CT |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1237 | CT | MD | Clinical Social Worker |
| LC50081357 | DC | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1334102400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1496880000000",
"number": "1679839997",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4115 WISCONSIN AVE NW",
"address_2": "APT. 501",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "20016",
"telephone_number": "347-254-4668"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1006 N MAIN STREET",
"city": "DAYVILLE",
"state": "CT",
"postal_code": "062412170",
"telephone_number": "860-774-2020",
"fax_number": "860-779-5437"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAGAN",
"first_name": "STEPHANIE",
"middle_name": "A",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-04-11",
"last_updated": "2017-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "DC",
"license": "LC50081357",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CT",
"license": "1237",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004040564",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dayville, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.