Provider Demographics
NPI:1184985970
Name:AGOSTA, LOU JR (PHD)
Entity type:Individual
Prefix:PROF
First Name:LOU
Middle Name:
Last Name:AGOSTA
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 N SHERIDAN RD
Mailing Address - Street 2:8C
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-3800
Mailing Address - Country:US
Mailing Address - Phone:773-203-0269
Mailing Address - Fax:
Practice Address - Street 1:SHERIDAN ROAD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660
Practice Address - Country:US
Practice Address - Phone:773-506-9511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst