Provider Demographics
NPI:1164802344
Name:AUGUSTIN, STEPHANIE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:AUGUSTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:G
Other - Last Name:AUGUSTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:L,BCBA
Mailing Address - Street 1:51 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-1740
Mailing Address - Country:US
Mailing Address - Phone:516-469-1415
Mailing Address - Fax:
Practice Address - Street 1:51 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-1740
Practice Address - Country:US
Practice Address - Phone:516-469-1415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000506103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst