Provider Demographics
NPI:1669621082
Name:D'AGOSTINO, PAUL
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:D'AGOSTINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 ALICE ST APT 16
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-5001
Mailing Address - Country:US
Mailing Address - Phone:510-590-6252
Mailing Address - Fax:
Practice Address - Street 1:27845 WHITMAN ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-4752
Practice Address - Country:US
Practice Address - Phone:510-293-8581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health