Provider Demographics
NPI:1447536974
Name:AGOSTINO, MARY BETH (LICSW)
Entity type:Individual
Prefix:
First Name:MARY BETH
Middle Name:
Last Name:AGOSTINO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100C STATE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH DEERFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01373-9654
Mailing Address - Country:US
Mailing Address - Phone:413-397-8986
Mailing Address - Fax:
Practice Address - Street 1:100C STATE RD
Practice Address - Street 2:
Practice Address - City:SOUTH DEERFIELD
Practice Address - State:MA
Practice Address - Zip Code:01373-9654
Practice Address - Country:US
Practice Address - Phone:413-397-8986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker