Provider Demographics
NPI:1528889201
Name:FREDERICK GAGER PSYCHOLOGY LLC
Entity type:Organization
Organization Name:FREDERICK GAGER PSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:GAGER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:603-903-9330
Mailing Address - Street 1:180 COURT ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3412
Mailing Address - Country:US
Mailing Address - Phone:603-903-9330
Mailing Address - Fax:
Practice Address - Street 1:81 COURT ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3409
Practice Address - Country:US
Practice Address - Phone:603-903-9330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-24
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)