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General NPI Number Information
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NPI Number | 1699612242
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Entity Type | Individual
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Provider Name | SAM AGOOS
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Gender | Male
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Dates
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Enumeration Date | 05/01/2026
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Last Update Date | 05/01/2026
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Provider Practice Location Address
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Address Line | 129 WINCHESTER RD
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City | MERION STATION
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State | PA
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Zip | 19066-1319
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Country | US
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Telephone | 610-405-0051
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Fax |
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Provider Business Mailing Address
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Address Line | 129 WINCHESTER RD
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City | MERION STATION
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State | PA
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Zip | 19066-1319
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Country | US
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Telephone |
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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 | CW023819
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License Number State | PA
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