Provider Demographics
NPI:1356472807
Name:D'AGNOLO, SHELLEY ANN RYAN (LCSW, ACSW, PHD)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:ANN RYAN
Last Name:D'AGNOLO
Suffix:
Gender:F
Credentials:LCSW, ACSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 ALLENS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3304
Mailing Address - Country:US
Mailing Address - Phone:585-442-4670
Mailing Address - Fax:
Practice Address - Street 1:110 ALLENS CREEK RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3304
Practice Address - Country:US
Practice Address - Phone:585-442-4670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0395431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical