Provider Demographics
NPI:1164629127
Name:TAUSTINE, LUCIE MARGO (PHD)
Entity Type:Individual
Prefix:DR
First Name:LUCIE
Middle Name:MARGO
Last Name:TAUSTINE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LUCIE
Other - Middle Name:MARGO
Other - Last Name:TAUSTINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:218 GRANNY RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-2130
Mailing Address - Country:US
Mailing Address - Phone:516-799-3320
Mailing Address - Fax:516-453-6798
Practice Address - Street 1:218 GRANNY RD
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-2130
Practice Address - Country:US
Practice Address - Phone:516-799-3320
Practice Address - Fax:516-799-3320
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011603103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01375268Medicaid
NYV0C911Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER