Mark G Fanger, ED.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2215 Issued in MA

Practice address

73 Roundwood Rd
Newton Upper Falls, MA 02464-1218

Phone

(617) 969-4040

Fax

(617) 795-2065

NPI assigned

Jan 26, 2006

Last updated

Jun 29, 2009By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 8

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 1, 2014 through Jan 1, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1138233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1246233600000",
    "number": "1730159146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "73 ROUNDWOOD RD",
            "city": "NEWTON",
            "state": "MA",
            "postal_code": "024641218",
            "telephone_number": "617-969-4040",
            "fax_number": "617-795-2065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "73 ROUNDWOOD RD",
            "city": "NEWTON UPPER FALLS",
            "state": "MA",
            "postal_code": "024641218",
            "telephone_number": "617-969-4040",
            "fax_number": "617-795-2065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANGER",
        "first_name": "MARK",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "ED.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-26",
        "last_updated": "2009-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "MA",
            "license": "2215",
            "primary": false
        },
        {
            "code": "103TA0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Adult Development & Aging",
            "state": "MA",
            "license": "2215",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "MA",
            "license": "2215",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "2215",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MA",
            "license": "2215",
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "MA",
            "license": "2215",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MA",
            "license": "2215",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• City Home Care, LLC
• Rebecca Cobb
• Barbara Dallin, LMHC, ATR
• Robin Dawkins, M.A.
• Paul Anthony Ezzy, MA
• Viky Filippou
• Freedom Home Care Services, Inc.
• Julia Elizabeth French, DC
• Leah M. Fygetakis, PH.D.
• Amanda K Gallagher, D.M.D.

• Clinical Psychologist in Newton Upper Falls, MA
• Providers in Newton Upper Falls, MA by specialty
• Clinical Psychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.