Provider Demographics
NPI:1326552399
Name:STEPHANIE AUGUSTIN, LICENSED BEHAVIOR ANALYST PLLC
Entity Type:Organization
Organization Name:STEPHANIE AUGUSTIN, LICENSED BEHAVIOR ANALYST PLLC
Other - Org Name:AUTISM JOURNEY & BEYOND, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF BEHAVIORAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:G
Authorized Official - Last Name:AUGUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, L-BCBA
Authorized Official - Phone:516-469-1415
Mailing Address - Street 1:3604 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11518-1565
Mailing Address - Country:US
Mailing Address - Phone:516-469-1415
Mailing Address - Fax:516-706-6549
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:516-706-6549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000506-1103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty