Provider Demographics
NPI:1700244944
Name:FAGER, NICK (LMHC)
Entity Type:Individual
Prefix:
First Name:NICK
Middle Name:
Last Name:FAGER
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 HORATIO ST APT 4C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-1561
Mailing Address - Country:US
Mailing Address - Phone:203-253-6602
Mailing Address - Fax:
Practice Address - Street 1:225 BROADWAY STE 3009
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-3071
Practice Address - Country:US
Practice Address - Phone:203-253-6602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health