Provider Demographics
NPI:1497443956
Name:AGENOR, MILDRED S
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:S
Last Name:AGENOR
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 1:300 E MARSHALL ST APT 329
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-2477
Mailing Address - Country:US
Mailing Address - Phone:973-549-8089
Mailing Address - Fax:
Practice Address - Street 1:300 E MARSHALL ST APT 329
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-2477
Practice Address - Country:US
Practice Address - Phone:973-549-8089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician