Provider Demographics
NPI:1063940765
Name:AGOSTINI, EMILY PATRICIA
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:PATRICIA
Last Name:AGOSTINI
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 1:1 LAMPLIGHTER WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT HERMON
Mailing Address - State:MA
Mailing Address - Zip Code:01354-9637
Mailing Address - Country:US
Mailing Address - Phone:413-441-9861
Mailing Address - Fax:
Practice Address - Street 1:9 CONFERENCE RD
Practice Address - Street 2:
Practice Address - City:MOUNT HERMON
Practice Address - State:MA
Practice Address - Zip Code:01354-9644
Practice Address - Country:US
Practice Address - Phone:203-699-6459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA225111104100000X
CT118901041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker