Provider Demographics
NPI:1376059634
Name:HORTEL-RIOS LOPEZ, AGUSTINA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:AGUSTINA
Middle Name:
Last Name:HORTEL-RIOS LOPEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 BRENTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-6666
Mailing Address - Country:US
Mailing Address - Phone:914-625-2641
Mailing Address - Fax:
Practice Address - Street 1:74 WEST ST
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6531
Practice Address - Country:US
Practice Address - Phone:203-470-9070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-22
Last Update Date:2017-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094542-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker