Provider Demographics
NPI:1962123133
Name:AGOSTO, ELIVETTE MARIE (MCSW)
Entity type:Individual
Prefix:MS
First Name:ELIVETTE
Middle Name:MARIE
Last Name:AGOSTO
Suffix:
Gender:F
Credentials:MCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. VENUS GARDEN CALLE TIJUANA
Mailing Address - Street 2:AE17
Mailing Address - City:PUERTO RICO
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-375-1735
Mailing Address - Fax:
Practice Address - Street 1:VENUS GARDEN C-TIJUANA
Practice Address - Street 2:CASA AE-17
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-375-1735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR160161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical