Provider Demographics
NPI:1720293574
Name:FEGAN, MARNIE ANN (PSYD)
Entity Type:Individual
Prefix:
First Name:MARNIE
Middle Name:ANN
Last Name:FEGAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-2001
Mailing Address - Country:US
Mailing Address - Phone:732-747-7665
Mailing Address - Fax:732-747-7665
Practice Address - Street 1:200 BROAD ST
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2001
Practice Address - Country:US
Practice Address - Phone:732-747-7665
Practice Address - Fax:732-747-7665
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3925101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health