Provider Demographics
NPI:1932463536
Name:ATWELL, AGATHA
Entity Type:Individual
Prefix:
First Name:AGATHA
Middle Name:
Last Name:ATWELL
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 1:9518 156TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-2827
Mailing Address - Country:US
Mailing Address - Phone:718-845-7812
Mailing Address - Fax:
Practice Address - Street 1:9409 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-2222
Practice Address - Country:US
Practice Address - Phone:917-767-7090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0430AAOtherSPECIAL EDUCATOR FOR EARLY INTERVENTION