Doctor Name: | PROF. C GAVRIEL FAGIN |
NPI Number: | 1073572681 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MA, LCSW, SOTS |
License Number: | 078842-1 |
Business Practice Address: | 967 Benton St Woodmere, NY - 115981706 |
Business Phone Number: | 9172578626 |
Business Fax Number: | |
Mailing Address: | 967 Benton St, WOODMERE |
State: | NY |
Postal Code: | 115981706 |
Phone Number: | 9172578626 |
Fax Number: | |
NPI Enumeration Date: | 03/22/2006 |
NPI Last Update Date: | 11/29/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 078842-1 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |