Provider Demographics
NPI:1659814853
Name:MARNIE FEGAN, PSY.D., P.C.
Entity Type:Organization
Organization Name:MARNIE FEGAN, PSY.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/SUPERVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARNIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FEGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:732-747-7765
Mailing Address - Street 1:272 BROAD ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-2044
Mailing Address - Country:US
Mailing Address - Phone:732-747-7665
Mailing Address - Fax:732-747-6444
Practice Address - Street 1:272 BROAD ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2044
Practice Address - Country:US
Practice Address - Phone:732-747-7665
Practice Address - Fax:732-747-6444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00391500103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty