Provider Demographics
NPI:1619581477
Name:AGNELLO, RACHEL (LSW)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:AGNELLO
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 FAIRHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432-1003
Mailing Address - Country:US
Mailing Address - Phone:201-925-7073
Mailing Address - Fax:
Practice Address - Street 1:46 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1864
Practice Address - Country:US
Practice Address - Phone:201-588-3491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC059153001041C0700X
NJ44SL06581800104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical