Provider Demographics
NPI:1770100968
Name:AGOSTINI, ALEX FRANCIS (MFT)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:FRANCIS
Last Name:AGOSTINI
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:654 ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037-3527
Mailing Address - Country:US
Mailing Address - Phone:860-830-7640
Mailing Address - Fax:
Practice Address - Street 1:128 GARDEN ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2254
Practice Address - Country:US
Practice Address - Phone:860-676-1134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2432106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist