Provider Demographics
NPI:1427644772
Name:D'AGOSTINO, LEAH M (LSW)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:M
Last Name:D'AGOSTINO
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 MANAYUNK AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-5027
Mailing Address - Country:US
Mailing Address - Phone:850-774-1764
Mailing Address - Fax:
Practice Address - Street 1:4121 MANAYUNK AVE FL 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-5027
Practice Address - Country:US
Practice Address - Phone:850-774-1764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0228301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical