Provider Demographics
NPI:1205344702
Name:NICOLE AGRESTO, PSYCHOLOGY P.A.
Entity type:Organization
Organization Name:NICOLE AGRESTO, PSYCHOLOGY P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:AGRESTO
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:727-685-0934
Mailing Address - Street 1:2150 49TH ST N STE E
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-5237
Mailing Address - Country:US
Mailing Address - Phone:727-685-0934
Mailing Address - Fax:727-279-4986
Practice Address - Street 1:2150 49TH ST N STE E
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-5237
Practice Address - Country:US
Practice Address - Phone:727-685-0934
Practice Address - Fax:727-279-4986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-18
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9016103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1629483698OtherNPI