Provider Demographics
NPI:1629008958
Name:AUGENBRAUN, HEDY (PHD)
Entity Type:Individual
Prefix:DR
First Name:HEDY
Middle Name:
Last Name:AUGENBRAUN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 FAIRFIELD WOODS RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-3323
Mailing Address - Country:US
Mailing Address - Phone:203-374-1055
Mailing Address - Fax:203-396-0182
Practice Address - Street 1:110 SOUNDVIEW AVENUE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:CT
Practice Address - Zip Code:06484
Practice Address - Country:US
Practice Address - Phone:203-374-1055
Practice Address - Fax:203-396-0182
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001139103TC0700X
NY014502-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004061176Medicaid
CT004061176Medicaid
CTOTH000Medicare UPIN