Provider Demographics
NPI:1538301502
Name:ADRIAN A. AGOSTA, LCSW, LLC
Entity Type:Organization
Organization Name:ADRIAN A. AGOSTA, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:AGOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:225-769-7575
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:225-769-7575
Mailing Address - Fax:225-923-1817
Practice Address - Street 1:9229 BLUEBONNET BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-2808
Practice Address - Country:US
Practice Address - Phone:225-769-7575
Practice Address - Fax:225-923-1817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty