Provider Demographics
NPI:1033276001
Name:FAGEN, DRENA (LCAT, LCSW-R)
Entity type:Individual
Prefix:
First Name:DRENA
Middle Name:
Last Name:FAGEN
Suffix:
Gender:F
Credentials:LCAT, LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 N 10TH ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-9325
Mailing Address - Country:US
Mailing Address - Phone:917-293-4642
Mailing Address - Fax:
Practice Address - Street 1:190 N 10TH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-9325
Practice Address - Country:US
Practice Address - Phone:917-293-4642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000144221700000X
NY0770351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist