Provider Demographics
NPI:1588319164
Name:FAGAN, OHNA (LCSW, LCADC)
Entity type:Individual
Prefix:
First Name:OHNA
Middle Name:
Last Name:FAGAN
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 SPRUCE CIR N
Mailing Address - Street 2:
Mailing Address - City:BARNEGAT
Mailing Address - State:NJ
Mailing Address - Zip Code:08005-2004
Mailing Address - Country:US
Mailing Address - Phone:609-290-8959
Mailing Address - Fax:
Practice Address - Street 1:860 S WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-2018
Practice Address - Country:US
Practice Address - Phone:609-567-0200
Practice Address - Fax:609-567-1951
Is Sole Proprietor?:No
Enumeration Date:2022-02-13
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00319500101YA0400X
NJ44SC060611001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)