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General NPI Number Information
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NPI Number | 1124635313
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Entity Type | Individual
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Provider Name | CHACY AGNELLO PSYD
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Gender | Female
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Dates
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Enumeration Date | 09/30/2020
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Last Update Date | 09/30/2020
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Provider Practice Location Address
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Address Line | 11 N IRVINE ST STE 6
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City | GREENVILLE
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State | SC
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Zip | 29601-4902
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Country | US
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Telephone | 864-671-1663
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Fax |
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Provider Business Mailing Address
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Address Line | 107 STONE AVE APT I
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City | EASLEY
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State | SC
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Zip | 29640-1353
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Country | US
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Telephone | 805-712-1508
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1639
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License Number State | SC
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