Provider Demographics
NPI:1053003608
Name:AGLIOTTA, MARY (MA, LAC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:AGLIOTTA
Suffix:
Gender:F
Credentials:MA, LAC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:SARAH
Other - Last Name:AGLIOTTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LAC, TIR, RYT
Mailing Address - Street 1:133 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3021
Mailing Address - Country:US
Mailing Address - Phone:202-680-8788
Mailing Address - Fax:
Practice Address - Street 1:233 MOUNT AIRY RD STE 100
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-2338
Practice Address - Country:US
Practice Address - Phone:908-434-6008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00343700101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor