Provider Demographics
NPI:1992949937
Name:D'AGOSTA, JOANNA MAXINE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:MAXINE
Last Name:D'AGOSTA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 LAURIE RD
Mailing Address - Street 2:
Mailing Address - City:LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:07850-1728
Mailing Address - Country:US
Mailing Address - Phone:973-601-0632
Mailing Address - Fax:
Practice Address - Street 1:350 SPARTA AVE
Practice Address - Street 2:C-2A
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1120
Practice Address - Country:US
Practice Address - Phone:973-726-4533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC047501001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical