Corey N Fagan, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY00001365 Issued in WA

Practice address

1 Guthrie Anx
Uw Box 351635
Seattle, WA 98195-0001

Phone

(206) 543-6511

Fax

(206) 616-8367

NPI assigned

Mar 21, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 1, 2016 through Apr 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• University of Washington

  dba UW Psychological Services & Training Ctr

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Seattle, WA
  • NPI 1861824211
  Authorized official Same address or phone
• University of Washington

  dba University of Washington Medical Center Ambulatory

  • Community/Retail Pharmacy
  • Seattle, WA
  • NPI 1013950336
  NPD (past)

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1851417927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 GUTHRIE ANX",
            "address_2": "UW BOX 351635",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981950001",
            "telephone_number": "206-543-6511",
            "fax_number": "206-616-8367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 GUTHRIE ANX",
            "address_2": "UW BOX 351635",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981950001",
            "telephone_number": "206-543-6511",
            "fax_number": "206-616-8367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGAN",
        "first_name": "COREY",
        "middle_name": "N",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "PY00001365",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCEBLUESHIELD",
            "identifier": "U09438",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charlie Alexander Fadness
• Mark Fadool, MS
• Hannah Marie Herbert Faeben, MD
• Alyssa Faella-Aversa, MSW, LICSW
• Faerland Terrace LLC
• Kevin Patrick Fagan, CRNA
• David Fagerholm, M.ED,MHP, LMHCA, NCC
• Paola Faggella, LMHC
• Richard Eliot Fagley, MD
• Shaeleen M Fagre, AU.D.

• Clinical Psychologist in Seattle, WA
• Providers in Seattle, WA by specialty
• Clinical Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.