Provider Demographics
NPI:1629328703
Name:AGULNIK, DEBRA BETH (LMFT)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:BETH
Last Name:AGULNIK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX308
Mailing Address - Street 2:1231 CONGRESS ST.
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-0000
Mailing Address - Country:US
Mailing Address - Phone:855-257-0848
Mailing Address - Fax:
Practice Address - Street 1:1231 CONGRESS ST.
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-0000
Practice Address - Country:US
Practice Address - Phone:855-257-0848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLMFT 000553-1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist