Provider Demographics
NPI:1154646974
Name:LARBI-AGGREY, AGNES (MSW)
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:
Last Name:LARBI-AGGREY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 ROUTE 22
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-4051
Mailing Address - Country:US
Mailing Address - Phone:845-278-2500
Mailing Address - Fax:845-278-0781
Practice Address - Street 1:1620 ROUTE 22
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-4051
Practice Address - Country:US
Practice Address - Phone:845-278-2500
Practice Address - Fax:845-278-0781
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-05
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073087-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00769457Medicaid