MEDICARE: NICOLE AGRESTO PSY.D,

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	103TC0700X	Clinical Psychologist	PY9016	FL

General Provider Information

NPI Number	:	1629483698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE AGRESTO PSY.D,

Provider Business Mailing Address
First Line	:	2150 49TH ST N STE E
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33710-5237
Country	:	US
Telephone Number	:	727-685-0934
Fax Number	:	727-279-4986

Provider Business Practice Location Address
First Line	:	2150 49TH ST N STE E
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33710-5237
Country	:	US
Telephone Number	:	727-685-0934
Fax Number	:	727-279-4986

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

Provider Enumeration Date	:	06/27/2014
Last Update Date	:	02/14/2019

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