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 |