Provider Demographics
NPI:1255525077
Name:PIERRE-LOUIS, AGATHE CHARLES (PSYD)
Entity type:Individual
Prefix:DR
First Name:AGATHE
Middle Name:CHARLES
Last Name:PIERRE-LOUIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3136 NYS ROUTE 207 STE 203
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL HALL
Mailing Address - State:NY
Mailing Address - Zip Code:10916-2234
Mailing Address - Country:US
Mailing Address - Phone:845-360-2547
Mailing Address - Fax:
Practice Address - Street 1:3136 NYS ROUTE 207
Practice Address - Street 2:
Practice Address - City:CAMPBELL HALL
Practice Address - State:NY
Practice Address - Zip Code:10916-2230
Practice Address - Country:US
Practice Address - Phone:845-360-2547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019201103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1205326394OtherGROUP NPI
NY1255525077OtherINDIVIDUAL NPI
NY03498015Medicaid