Provider Demographics
NPI:1275355877
Name:AGATHOCLEOUS, MARKOS STAVROS (LMSW)
Entity type:Individual
Prefix:
First Name:MARKOS
Middle Name:STAVROS
Last Name:AGATHOCLEOUS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4843 CLEARVIEW EXPY
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-1042
Mailing Address - Country:US
Mailing Address - Phone:347-406-0771
Mailing Address - Fax:
Practice Address - Street 1:6603 BEACH CHANNEL DR
Practice Address - Street 2:
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692-1433
Practice Address - Country:US
Practice Address - Phone:718-471-8671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124513-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker