Provider Demographics
NPI:1700012382
Name:D'AGOSTINO, DONALD C (LICSW)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:C
Last Name:D'AGOSTINO
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 ROBINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2156
Mailing Address - Country:US
Mailing Address - Phone:617-390-1362
Mailing Address - Fax:617-390-1595
Practice Address - Street 1:49 ROBINWOOD AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2156
Practice Address - Country:US
Practice Address - Phone:617-390-1362
Practice Address - Fax:617-390-1595
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1006141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical