Provider Demographics
NPI:1851475511
Name:AGOSTINO, JILLIAN LINDSEY (MSW)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:LINDSEY
Last Name:AGOSTINO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 CROSS ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-7829
Mailing Address - Country:US
Mailing Address - Phone:781-333-4082
Mailing Address - Fax:
Practice Address - Street 1:430 N CANAL ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1246
Practice Address - Country:US
Practice Address - Phone:978-682-7289
Practice Address - Fax:978-686-2954
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor