Provider Demographics
NPI:1255667424
Name:AGOSTO, KATHLEEN A (MS)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:A
Last Name:AGOSTO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:488 GLASSBORO ROAD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WOODBURY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08097-1400
Mailing Address - Country:US
Mailing Address - Phone:609-895-7503
Mailing Address - Fax:856-691-3014
Practice Address - Street 1:488 GLASSBORO RD
Practice Address - Street 2:SUITE 204
Practice Address - City:WOODBURY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08097-1400
Practice Address - Country:US
Practice Address - Phone:609-895-7503
Practice Address - Fax:856-691-3014
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FI00160400106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist