Provider Demographics
NPI:1083771018
Name:WOHL, AGNES (LCSW)
Entity Type:Individual
Prefix:MS
First Name:AGNES
Middle Name:
Last Name:WOHL
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 1:366 N BROADWAY STE 201
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2000
Mailing Address - Country:US
Mailing Address - Phone:516-625-1750
Mailing Address - Fax:516-465-0370
Practice Address - Street 1:366 N BROADWAY STE 201
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2000
Practice Address - Country:US
Practice Address - Phone:516-625-1750
Practice Address - Fax:516-465-0370
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY273481R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0088183OtherGHI
NYP0507872OtherOXFORD
NYP0507872OtherOXFORD