Provider Demographics
NPI:1407514078
Name:AGNELLO, JASON ANTHONY (LMSW)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ANTHONY
Last Name:AGNELLO
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 KIRBY AVE
Mailing Address - Street 2:
Mailing Address - City:LACKAWANNA
Mailing Address - State:NY
Mailing Address - Zip Code:14218-3155
Mailing Address - Country:US
Mailing Address - Phone:716-997-1001
Mailing Address - Fax:
Practice Address - Street 1:4535 SOUTHWESTERN BLVD STE 807
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-1860
Practice Address - Country:US
Practice Address - Phone:716-980-1885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-01
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor