Provider Demographics
NPI:1912238957
Name:AGOSTINHO, RICHARD (LCSW)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:AGOSTINHO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11132
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33339-1132
Mailing Address - Country:US
Mailing Address - Phone:954-801-1888
Mailing Address - Fax:
Practice Address - Street 1:351 SW 136TH AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33325-3153
Practice Address - Country:US
Practice Address - Phone:954-801-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-14
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW141631041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical