Provider Demographics
NPI:1013139716
Name:DIAS, AGNELO B (ED D, LCSW)
Entity Type:Individual
Prefix:DR
First Name:AGNELO
Middle Name:B
Last Name:DIAS
Suffix:
Gender:M
Credentials:ED D, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 DOGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-3128
Mailing Address - Country:US
Mailing Address - Phone:516-414-1953
Mailing Address - Fax:516-414-1953
Practice Address - Street 1:2174 HEWLETT AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3606
Practice Address - Country:US
Practice Address - Phone:516-513-2678
Practice Address - Fax:516-414-1953
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY73 0799251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical