Provider Demographics
NPI:1083081079
Name:D'AGOSTINO, DOREEN JOANNE (PMHNP, CRNP)
Entity Type:Individual
Prefix:MS
First Name:DOREEN
Middle Name:JOANNE
Last Name:D'AGOSTINO
Suffix:
Gender:F
Credentials:PMHNP, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 BOBALA RD
Mailing Address - Street 2:MT TOM CENTER FOR MENTAL HEALTH
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-9632
Mailing Address - Country:US
Mailing Address - Phone:413-536-5473
Mailing Address - Fax:
Practice Address - Street 1:40 BOBALA RD
Practice Address - Street 2:MT TOM CENTER FOR MENTAL HEALTH
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-9632
Practice Address - Country:US
Practice Address - Phone:413-536-5473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-26
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015274363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health