Jennifer D'Agostino

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

20043536B Issued in IN

Practice address

2613 Lakewood Dr
Dyer, IN 46311-2133

Phone

(626) 554-0408

NPI assigned

Aug 10, 2018

Last updated

Dec 17, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Jennifer D'Agostino Other name

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southlake Community Mental Health Center Inc.

  dba Regional Mental Health Center

  • Clinic/Center
  • Merrillville, IN
  • NPI 1821081290
  Medicare reassignment NPD
• Thrive Counseling LLC

  dba Thriveworks

  • Mental Health Counselor
  • Lynchburg, VA
  • NPI 1215181300

  IN

  Medicare reassignment NPD
• Jovial Mental Health LLC

  • Clinical Psychologist
  • Dyer, IN
  • NPI 1477243715
  NPD Authorized official
• Anxiety & Ocd Behavioral Health Center

  • Clinical Psychologist
  • Munster, IN
  • NPI 1144640582
  NPD (past)
• Southlake Community Mental Health Center, Inc.

  dba Regional Health Clinic

  • Federally Qualified Health Center (FQHC)
  • Merrillville, IN
  • NPI 1477007292
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1533859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702771200000",
    "number": "1528547494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2613 LAKEWOOD DR",
            "city": "DYER",
            "state": "IN",
            "postal_code": "463112133",
            "telephone_number": "626-554-0408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2613 LAKEWOOD DR",
            "city": "DYER",
            "state": "IN",
            "postal_code": "463112133",
            "telephone_number": "626-554-0408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "D'AGOSTINO",
        "first_name": "JENNIFER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-10",
        "last_updated": "2023-12-17",
        "certification_date": "2023-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20043536B",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20043536A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "D'AGOSTINO",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jennifer Cuevas
• Eric Culp, D.O.
• Jonathan Cultura, PT
• James Cunningham
• Noel Cusick
• Chau Thi Minh Dang
• Gerard M Davidson, DO
• Ryan Davidson, PHARMD
• Fernando Miguel De Lemos Figueira, MD
• Erica Lynn Deenihan, FNP

• Clinical Psychologist in Dyer, IN
• Providers in Dyer, IN by specialty
• Clinical Psychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.