MEDICARE: CHRISTINE M AGNELLO LPC

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	101YP2500X	Professional Counselor	PC005376	PA

General Provider Information

NPI Number	:	1417285297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE M AGNELLO LPC

Provider Business Mailing Address
First Line	:	4934 PEACH ST FL 2
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16509-2043
Country	:	US
Telephone Number	:	814-315-2828
Fax Number	:

Provider Business Practice Location Address
First Line	:	4934 PEACH ST FL 2
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16509-2043
Country	:	US
Telephone Number	:	814-315-2828
Fax Number	:

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

Provider Enumeration Date	:	12/06/2009
Last Update Date	:	09/04/2020

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