Provider Demographics
NPI:1740592286
Name:AGOUSTO, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:AGOUSTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:666 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-3706
Mailing Address - Country:US
Mailing Address - Phone:718-230-8600
Mailing Address - Fax:718-228-2013
Practice Address - Street 1:666 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-3706
Practice Address - Country:US
Practice Address - Phone:718-230-8600
Practice Address - Fax:718-228-2013
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
24621101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)