Provider Demographics
NPI:1003464900
Name:AGURTO, MELISSA ERIN (LMSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ERIN
Last Name:AGURTO
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 1:84 CARNATION RD
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-2015
Mailing Address - Country:US
Mailing Address - Phone:516-782-4604
Mailing Address - Fax:
Practice Address - Street 1:18730 GRAND CENTRAL PKWY
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5819
Practice Address - Country:US
Practice Address - Phone:718-264-2931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1061851041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool