Provider Demographics
NPI:1699737452
Name:AGOSTO, RICHARD (PHD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:AGOSTO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9340 NE 76TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-3721
Mailing Address - Country:US
Mailing Address - Phone:360-253-4912
Mailing Address - Fax:360-253-5170
Practice Address - Street 1:5220 NE HAZEL DELL AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-1242
Practice Address - Country:US
Practice Address - Phone:360-253-4912
Practice Address - Fax:360-253-5170
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002544103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8352346Medicaid
WA8352346Medicaid
R09976Medicare UPIN