MEDICARE: DR. JOSEPH ANTHONY D'AGOSTINO PH.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	PSY 001741	GA
2	103TC0700X	Clinical Psychologist	PY 004738	FL

General Provider Information

NPI Number	:	1952748048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH ANTHONY D'AGOSTINO PH.D.

Provider Business Mailing Address
First Line	:	236 RIVER OAK DR
Second Line	:
City	:	EATONTON
State	:	GA
Zip	:	31024-7201
Country	:	US
Telephone Number	:	706-485-7659
Fax Number	:

Provider Business Practice Location Address
First Line	:	236 RIVER OAK DR
Second Line	:
City	:	EATONTON
State	:	GA
Zip	:	31024-7201
Country	:	US
Telephone Number	:	706-485-7659
Fax Number	:

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

Provider Enumeration Date	:	05/29/2013
Last Update Date	:	05/29/2013

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