Healthcare Provider Details

I. General information

NPI: 1467825331
Provider Name (Legal Business Name): STEPHANY AGUDELO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2015
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MANCHESTER RD
POUGHKEEPSIE NY
12603-2596
US

IV. Provider business mailing address

141 PUMPHOUSE RD
BREWSTER NY
10509-2908
US

V. Phone/Fax

Practice location:
  • Phone: 845-452-1110
  • Fax:
Mailing address:
  • Phone: 914-497-7912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number092387
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: