MEDICARE: MRS. KATHLEEN A AGOSTO M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	37FI00160400	NJ

General Provider Information

NPI Number	:	1255667424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN A AGOSTO M.S.

Provider Business Mailing Address
First Line	:	488 GLASSBORO ROAD
Second Line	:	SUITE 204
City	:	WOODBURY HEIGHTS
State	:	NJ
Zip	:	08097-1400
Country	:	US
Telephone Number	:	609-895-7503
Fax Number	:	856-691-3014

Provider Business Practice Location Address
First Line	:	488 GLASSBORO RD
Second Line	:	SUITE 204
City	:	WOODBURY HEIGHTS
State	:	NJ
Zip	:	08097-1400
Country	:	US
Telephone Number	:	609-895-7503
Fax Number	:	856-691-3014

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2009
Last Update Date	:	10/23/2009

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