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NPI Code Detail

MEDICARE: ALEX FRANCIS AGOSTINI MFT

MEDICARE: ALEX FRANCIS AGOSTINI MFT
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
1106H00000XMarriage & Family Therapist2432CT

General Provider Information

NPI Number : 1770100968
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEX FRANCIS AGOSTINI MFT
Provider Business Mailing Address
First Line : 654 ORCHARD RD
Second Line :
City : BERLIN
State : CT
Zip : 06037-3527
Country : US
Telephone Number : 860-830-7640
Fax Number :
Provider Business Practice Location Address
First Line : 128 GARDEN ST
Second Line :
City : FARMINGTON
State : CT
Zip : 06032-2254
Country : US
Telephone Number : 860-676-1134
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2020
Last Update Date : 07/03/2020

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