Provider Demographics
NPI:1629234596
Name:FAGHAN, ROBERT F (MLADC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:F
Last Name:FAGHAN
Suffix:
Gender:M
Credentials:MLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PUZZLE LN UNIT 2-1
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NH
Mailing Address - Zip Code:03858-3721
Mailing Address - Country:US
Mailing Address - Phone:603-702-2461
Mailing Address - Fax:
Practice Address - Street 1:2 PUZZLE LN UNIT 2-1
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NH
Practice Address - Zip Code:03858-3721
Practice Address - Country:US
Practice Address - Phone:603-702-2461
Practice Address - Fax:866-583-7733
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2020-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)