Provider Demographics
NPI:1063514214
Name:AGRESTA, VICTORIA HELEN
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:HELEN
Last Name:AGRESTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 WAYNE CT
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-9108
Mailing Address - Country:US
Mailing Address - Phone:518-793-3971
Mailing Address - Fax:
Practice Address - Street 1:123 DIXON RD
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-2133
Practice Address - Country:US
Practice Address - Phone:518-798-9187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000567101YM0800X
NY101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool