Provider Demographics
NPI:1508089293
Name:AGOSTA, ADRIAN ANTHONY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:ANTHONY
Last Name:AGOSTA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7940 WRENWOOD BLVD APT G
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1766
Mailing Address - Country:US
Mailing Address - Phone:225-923-1817
Mailing Address - Fax:
Practice Address - Street 1:7656 JEFFERSON HWY
Practice Address - Street 2:SUITE 1A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1101
Practice Address - Country:US
Practice Address - Phone:225-927-2455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA43121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical