Provider Demographics
NPI:1609166909
Name:AGOSTO, SAMARY
Entity Type:Individual
Prefix:MS
First Name:SAMARY
Middle Name:
Last Name:AGOSTO
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 1:39 ATLAS ST
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-3904
Mailing Address - Country:US
Mailing Address - Phone:203-442-3370
Mailing Address - Fax:
Practice Address - Street 1:103 WOODLAND ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1233
Practice Address - Country:US
Practice Address - Phone:860-520-6244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor