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General NPI Number Information
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NPI Number | 1902464043
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Entity Type | Organization
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Legal Business Name | AGNELLO THERAPY GROUP, L.L.C.
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Dates
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Enumeration Date | 06/04/2019
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Last Update Date | 05/27/2023
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Provider Practice Location Address
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Address Line | 107 E MOUNT PLEASANT AVE STE 8
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City | LIVINGSTON
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State | NJ
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Zip | 07039-3038
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Country | US
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Telephone | 973-476-6371
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Fax |
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Provider Business Mailing Address
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Address Line | 33 CAMBRIDGE AVE
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City | DENVILLE
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State | NJ
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Zip | 07834-9675
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Country | US
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Telephone | 973-476-6371
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | KRISTEN JUSTINE AGNELLO
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Credential | LPC, LMHC, NCC, ACS
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Telephone | 973-476-6371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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