Provider Demographics
NPI:1194187773
Name:FONTAINE, AURA LEE (TEACHER)
Entity Type:Individual
Prefix:MRS
First Name:AURA
Middle Name:LEE
Last Name:FONTAINE
Suffix:
Gender:F
Credentials:TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 HEATHERDELL RD
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-1520
Mailing Address - Country:US
Mailing Address - Phone:914-426-7330
Mailing Address - Fax:
Practice Address - Street 1:1318 60TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-5018
Practice Address - Country:US
Practice Address - Phone:718-686-5911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY401281171M00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator