Provider Demographics
NPI:1336268283
Name:FOGARTY, DANA ANDREW (MA)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:ANDREW
Last Name:FOGARTY
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:ANDREW
Other - Last Name:FOGARTY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:25 LOCUST ST APT 803
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-7013
Mailing Address - Country:US
Mailing Address - Phone:603-781-2829
Mailing Address - Fax:
Practice Address - Street 1:116 SUMMER ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6032
Practice Address - Country:US
Practice Address - Phone:781-871-6550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1336268283101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health