| Doctor Name: | MARK GAGNON |
| NPI Number: | 1073822946 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSW, LICSW, LADC |
| License Number: | 0890054418 |
| Business Practice Address: | 206 Glen St Glens Falls, NY - 128013584 |
| Business Phone Number: | 5183215592 |
| Business Fax Number: | |
| Mailing Address: | Po Box 612, SARATOGA SPRINGS |
| State: | NY |
| Postal Code: | 128660612 |
| Phone Number: | 5183215592 |
| Fax Number: | |
| NPI Enumeration Date: | 09/27/2010 |
| NPI Last Update Date: | 10/05/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 0890054418 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | VT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |