Provider Demographics
NPI:1548216948
Name:AGOADO, BARRY I (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:I
Last Name:AGOADO
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 1:10917 86TH AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-1608
Mailing Address - Country:US
Mailing Address - Phone:718-846-3116
Mailing Address - Fax:718-847-4658
Practice Address - Street 1:10917 86TH AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-1608
Practice Address - Country:US
Practice Address - Phone:718-846-3116
Practice Address - Fax:718-847-4658
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR040261-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00526Medicare PIN