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General NPI Number Information
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NPI Number | 1962123133
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Entity Type | Individual
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Provider Name | ELIVETTE MARIE AGOSTO MCSW
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Gender | Female
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Dates
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Enumeration Date | 09/07/2022
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Last Update Date | 01/02/2024
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Provider Practice Location Address
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Address Line | VENUS GARDEN C-TIJUANA CASA AE-17
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City | SAN JUAN
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State | PR
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Zip | 00926
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Country | US
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Telephone | 787-375-1735
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Fax |
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Provider Business Mailing Address
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Address Line | URB. VENUS GARDEN CALLE TIJUANA AE17
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City | PUERTO RICO
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State | PR
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Zip | 00926
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Country | US
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Telephone | 787-375-1735
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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 | 16016
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License Number State | PR
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