Individual provider · NPI-1

Suraija Agosto, LAC

Counselor, Mental Health · New Providence, NJ

NPI number1326895251
StatusActive
Last updated in NPPESApr 30, 2024

Details

NPI
1326895251
Entity type
Individual (NPI-1)
Name
Ms. Suraija Agosto
Credential
LAC
Sex
Female
Sole proprietor
No
Enumeration date
Apr 30, 2024
Certification date
Apr 30, 2024
Last updated
Apr 30, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
101YM0800X Counselor, Mental Health37AC00643500NJYes
225600000X Dance Therapist1485–

Practice location

121 Chanlon Rd
New Providence, NJ 07974-1543

Phone 973-299-9954

Mailing address

388 Huguenot Ave
Union, NJ 07083-7557

Phone 718-924-9935

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