Provider Demographics
NPI:1659135986
Name:PSYCHIATRIC EDGE LLC
Entity type:Organization
Organization Name:PSYCHIATRIC EDGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:GAGNON
Authorized Official - Suffix:JR
Authorized Official - Credentials:CRNP,PMHNP-BC, MSN
Authorized Official - Phone:856-699-1719
Mailing Address - Street 1:851 DUPORTAIL RD FL 2
Mailing Address - Street 2:
Mailing Address - City:CHESTERBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19087-5575
Mailing Address - Country:US
Mailing Address - Phone:856-699-1719
Mailing Address - Fax:856-249-9109
Practice Address - Street 1:851 DUPORTAIL RD FL 2
Practice Address - Street 2:
Practice Address - City:CHESTERBROOK
Practice Address - State:PA
Practice Address - Zip Code:19087-5575
Practice Address - Country:US
Practice Address - Phone:856-699-1719
Practice Address - Fax:856-249-9109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-07
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health