Provider Demographics
NPI:1841693520
Name:D'AGOSTINO, CLARA
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:
Last Name:D'AGOSTINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 CASA DEL REY DR
Mailing Address - Street 2:
Mailing Address - City:LA HABRA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:90631-8330
Mailing Address - Country:US
Mailing Address - Phone:562-233-0695
Mailing Address - Fax:
Practice Address - Street 1:1260 CASA DEL REY DR
Practice Address - Street 2:
Practice Address - City:LA HABRA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:90631-8330
Practice Address - Country:US
Practice Address - Phone:562-233-0695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS177421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical