Healthcare Provider Details

I. General information

NPI: 1003972811
Provider Name (Legal Business Name): JOYCLYN R AGATONE LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 12/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 KATE WAGNER RD.
WESTMINSTER MD
21157
US

IV. Provider business mailing address

59 KATE WAGNER RD.
WESTMINSTER MD
21157
US

V. Phone/Fax

Practice location:
  • Phone: 410-848-2500
  • Fax: 410-876-3016
Mailing address:
  • Phone: 410-848-2500
  • Fax: 410-876-3016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11438
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: