Individual
AGATHA ATWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9409 JAMAICA AVE, WOODHAVEN, NY 11421-2222
(917) 767-7090
Mailing address
9518 156TH AVE, HOWARD BEACH, NY 11414-2827
(718) 845-7812
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0430AA
SPECIAL EDUCATOR FOR EARLY INTERVENTION
NY
Enumeration date
06/27/2012
Last updated
06/27/2012
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