Provider Demographics
NPI:1629629381
Name:LIANZO, AUGUSTIN JOHN (LMHC)
Entity Type:Individual
Prefix:MR
First Name:AUGUSTIN
Middle Name:JOHN
Last Name:LIANZO
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10118 67TH DR APT 1R
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2784
Mailing Address - Country:US
Mailing Address - Phone:347-881-6255
Mailing Address - Fax:
Practice Address - Street 1:115 W 31ST ST FL 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3596
Practice Address - Country:US
Practice Address - Phone:212-564-6006
Practice Address - Fax:212-564-3440
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP13278101YM0800X
NY010742101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health