Provider Demographics
NPI:1922241504
Name:AUGUSTUS, BERTHA (MSW)
Entity Type:Individual
Prefix:MS
First Name:BERTHA
Middle Name:
Last Name:AUGUSTUS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1485 SOUTH SEMORAN BLVD
Mailing Address - Street 2:1402
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792
Mailing Address - Country:US
Mailing Address - Phone:321-397-3000
Mailing Address - Fax:321-397-3000
Practice Address - Street 1:5115 ANZIO ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819
Practice Address - Country:US
Practice Address - Phone:407-266-1714
Practice Address - Fax:407-226-2922
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health