Provider Demographics
NPI:1790378693
Name:CHIONE, AGNES GENEVIEVE
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:GENEVIEVE
Last Name:CHIONE
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 1:931 BUENA VISTA ST STE 200
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-1713
Mailing Address - Country:US
Mailing Address - Phone:626-671-8866
Mailing Address - Fax:
Practice Address - Street 1:931 BUENA VISTA ST STE 200
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-1713
Practice Address - Country:US
Practice Address - Phone:626-671-8866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILC500-0070-1968106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician