Glenn Scott Fagen, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6793 Issued in MA

Practice address

100 King Street
Suite 303
Northampton, MA 01060

Phone

(413) 584-8339

Fax

(413) 584-8807

NPI assigned

Jul 11, 2006

Sex

Male

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

Enrolled in MA

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.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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.

• Glenn S. Fagen PHD Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Northampton, MA
  • NPI 1518261874
  Medicare reassignment Authorized official
• Pioneer Spine and Sports Physicians PC

  • Physical Medicine & Rehabilitation Physician
  • West Springfield, MA
  • NPI 1346282621
  NPD (past)

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1932134947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 KING STREET",
            "address_2": "SUITE 303",
            "city": "NORTHAMPTON",
            "state": "MA",
            "postal_code": "01060",
            "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 STREET",
            "address_2": "SUITE 303",
            "city": "NORTHAMPTON",
            "state": "MA",
            "postal_code": "01060",
            "telephone_number": "413-584-8339",
            "fax_number": "413-584-8807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGEN",
        "first_name": "GLENN",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MA",
            "license": "6793",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0524484",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristin L Evans, LICSW
• Michael Joseph Evans, D.C.
• Peter Jansen Everett, M.D.
• Evolve Therapy Solutions, LLC
• Katharine Ewall
• Family Connections Center, LLC
• Family Health and Wellness Center LLC
• John F. Farrell
• Tyler Scott Fassett, PHARMD
• Sander Joshua Fasten, DMD

• Psychologist in Northampton, MA
• Providers in Northampton, MA by specialty
• Psychologist in Massachusetts

• 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.