MEDICARE: JENNIFER AGOSTO BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710365275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER AGOSTO BCBA

Provider Business Mailing Address
First Line	:	626 LOCUST CT
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-3425
Country	:	US
Telephone Number	:	516-633-5041
Fax Number	:

Provider Business Practice Location Address
First Line	:	3283 CANOE CREEK RD
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34772
Country	:	US
Telephone Number	:	407-498-4079
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2015
Last Update Date	:	11/28/2022

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