Provider Demographics
NPI:1124179239
Name:AGOOS, ELLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:
Last Name:AGOOS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 LEXINGTON AVE
Mailing Address - Street 2:SUITE 3D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6839
Mailing Address - Country:US
Mailing Address - Phone:212-679-0042
Mailing Address - Fax:212-288-9833
Practice Address - Street 1:184 LEXINGTON AVE
Practice Address - Street 2:SUITE 3D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6839
Practice Address - Country:US
Practice Address - Phone:212-679-0042
Practice Address - Fax:212-288-9833
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR023450101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN01941Medicare ID - Type Unspecified