Provider Demographics
NPI:1376807172
Name:D'AGOSTINO, JENNIFER FORSTROM (MS, LMHC, NCC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:FORSTROM
Last Name:D'AGOSTINO
Suffix:
Gender:F
Credentials:MS, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 BEDFORD RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-3029
Mailing Address - Country:US
Mailing Address - Phone:914-806-3232
Mailing Address - Fax:
Practice Address - Street 1:427 BEDFORD RD
Practice Address - Street 2:SUITE 150
Practice Address - City:PLEASANTVILLE
Practice Address - State:NY
Practice Address - Zip Code:10570-3029
Practice Address - Country:US
Practice Address - Phone:914-806-3232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250919101Y00000X
NY004807101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor