Provider Demographics
NPI:1083037949
Name:AGAHIU, LADI (LCSW)
Entity Type:Individual
Prefix:MR
First Name:LADI
Middle Name:
Last Name:AGAHIU
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 1:196 CLINTON AVE
Mailing Address - Street 2:APT B43
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-3437
Mailing Address - Country:US
Mailing Address - Phone:917-627-2227
Mailing Address - Fax:
Practice Address - Street 1:225 BROADWAY STE 2070
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-3001
Practice Address - Country:US
Practice Address - Phone:212-227-4343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-29
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086757104100000X
NY0904091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY090409OtherNYS OFFICE OF PROFESSIONS