Healthcare Provider Details

I. General information

NPI: 1710365275
Provider Name (Legal Business Name): JENNIFER AGOSTO BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER AGOSTO

II. Dates (important events)

Enumeration Date: 05/15/2015
Last Update Date: 11/28/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3283 CANOE CREEK RD
SAINT CLOUD FL
34772
US

IV. Provider business mailing address

626 LOCUST CT
WINTER SPRINGS FL
32708-3425
US

V. Phone/Fax

Practice location:
  • Phone: 407-498-4079
  • Fax:
Mailing address:
  • Phone: 516-633-5041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: