Provider Demographics
NPI:1871644880
Name:AGIN, ADELE I (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ADELE
Middle Name:I
Last Name:AGIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 UNION ST
Mailing Address - Street 2:APT 1H
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-1748
Mailing Address - Country:US
Mailing Address - Phone:718-460-2216
Mailing Address - Fax:
Practice Address - Street 1:LEXINGTON CENTER FOR MENTAL HEALTH SERVICES, INC.
Practice Address - Street 2:30TH AVE & 75TH STREET
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11370
Practice Address - Country:US
Practice Address - Phone:718-350-3110
Practice Address - Fax:718-350-3072
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0736411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical