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General NPI Number Information
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NPI Number | 1639224645
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Entity Type | Individual
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Provider Name | MATILDA CATHY AGAR LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1 GATEWAY PLZ 401
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City | PORT CHESTER
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State | NY
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Zip | 10573-4674
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Country | US
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Telephone | 914-872-5290
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Fax | 914-948-0299
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Provider Business Mailing Address
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Address Line | 3385 MOHEGAN AVE
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City | MOHEGAN LAKE
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State | NY
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Zip | 10547-1317
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Country | US
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Telephone | 914-526-2740
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | RO33684-1
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License Number State | NY
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