Provider Demographics
NPI:1700367976
Name:AUGUSTINO, PATRICIA K (LSW, MSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:K
Last Name:AUGUSTINO
Suffix:
Gender:F
Credentials:LSW, MSW
Other - Prefix:
Other - First Name:PATTI
Other - Middle Name:K
Other - Last Name:AUGUSTINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LSW, MSW
Mailing Address - Street 1:538 LIPPINCOTT DR BLDG E
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4806
Mailing Address - Country:US
Mailing Address - Phone:856-489-0505
Mailing Address - Fax:856-489-0435
Practice Address - Street 1:538 LIPPINCOTT DR BLDG E
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4806
Practice Address - Country:US
Practice Address - Phone:856-489-0505
Practice Address - Fax:856-489-0435
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL04969100104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ44SL04969100OtherCERTIFICATION