Provider Demographics
NPI:1902464043
Name:AGNELLO THERAPY GROUP, L.L.C.
Entity Type:Organization
Organization Name:AGNELLO THERAPY GROUP, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:JUSTINE
Authorized Official - Last Name:AGNELLO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMHC, NCC, ACS
Authorized Official - Phone:973-476-6371
Mailing Address - Street 1:33 CAMBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-9675
Mailing Address - Country:US
Mailing Address - Phone:973-476-6371
Mailing Address - Fax:
Practice Address - Street 1:107 E MOUNT PLEASANT AVE STE 8
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-3038
Practice Address - Country:US
Practice Address - Phone:973-476-6371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-04
Last Update Date:2023-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty