Provider Demographics
NPI:1265574511
Name:FAGIN JR, VINCENT B (LMFT, LCPC)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:B
Last Name:FAGIN JR
Suffix:
Gender:M
Credentials:LMFT, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:METROPOLITAN FAMILY SERVICES
Mailing Address - Street 2:10537 SOUTH ROBERTS ROAD
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-0000
Mailing Address - Country:US
Mailing Address - Phone:708-974-2498
Mailing Address - Fax:708-974-2498
Practice Address - Street 1:METROPOLITAN FAMILY SERVICES
Practice Address - Street 2:222 E. WILLOW AVE.
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5421
Practice Address - Country:US
Practice Address - Phone:630-784-4817
Practice Address - Fax:630-682-5276
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health