Provider Demographics
NPI:1962803676
Name:AGOSTINO, GINA (LMSW)
Entity type:Individual
Prefix:MS
First Name:GINA
Middle Name:
Last Name:AGOSTINO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 LOCUST HILL AVE
Mailing Address - Street 2:C/O WJCS FAMILY MATTERS PROGRAM
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-2917
Mailing Address - Country:US
Mailing Address - Phone:914-376-5124
Mailing Address - Fax:914-457-2386
Practice Address - Street 1:135 LOCUST HILL AVE
Practice Address - Street 2:C/O WJCS FAMILY MATTERS PROGRAM
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-2917
Practice Address - Country:US
Practice Address - Phone:914-376-5124
Practice Address - Fax:914-457-2386
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC013425101YM0800X
NY095850104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker