Provider Demographics
NPI:1861650566
Name:AUGUSTYNIAK, KRISTINE M (PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:M
Last Name:AUGUSTYNIAK
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 1:765 CAYUGA ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092
Mailing Address - Country:US
Mailing Address - Phone:716-327-1094
Mailing Address - Fax:716-405-7717
Practice Address - Street 1:765 CAYUGA ST
Practice Address - Street 2:SUITE 1
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092
Practice Address - Country:US
Practice Address - Phone:716-327-1094
Practice Address - Fax:716-405-7717
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013682103TC0700X
NY0136822103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical