Provider Demographics
NPI:1316559313
Name:AGOSTO, MARLENE ROSALINA
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:ROSALINA
Last Name:AGOSTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2054 COLDWATER CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-8702
Mailing Address - Country:US
Mailing Address - Phone:317-675-0401
Mailing Address - Fax:
Practice Address - Street 1:2204 DUKE ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-2238
Practice Address - Country:US
Practice Address - Phone:317-675-0401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No171R00000XOther Service ProvidersInterpreter
No172V00000XOther Service ProvidersCommunity Health Worker
No175T00000XOther Service ProvidersPeer Specialist
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No174H00000XOther Service ProvidersHealth Educator
No376J00000XNursing Service Related ProvidersHomemaker