Provider Demographics
NPI:1447138417
Name:FAGAN, SAMANTHA KATHLEEN (BCBA,LBA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:KATHLEEN
Last Name:FAGAN
Suffix:
Gender:F
Credentials:BCBA,LBA
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:KATHLEEN
Other - Last Name:GETLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:542 AMHERST ST STE B
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-1016
Mailing Address - Country:US
Mailing Address - Phone:561-323-6593
Mailing Address - Fax:
Practice Address - Street 1:15000 COMMERCE PKWY STE C
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-2212
Practice Address - Country:US
Practice Address - Phone:877-803-1830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst