MEDICARE: NATHALIE AUGUSTIN LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	37AC00595600	NJ

General Provider Information

NPI Number	:	1043980618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHALIE AUGUSTIN LAC

Provider Business Mailing Address
First Line	:	105 WILLIAMSON AVE
Second Line	:
City	:	HILLSIDE
State	:	NJ
Zip	:	07205-1607
Country	:	US
Telephone Number	:	908-659-6923
Fax Number	:

Provider Business Practice Location Address
First Line	:	611 US HIGHWAY 46 W STE 100
Second Line	:
City	:	HASBROUCK HEIGHTS
State	:	NJ
Zip	:	07604-3120
Country	:	US
Telephone Number	:	201-478-4183
Fax Number	:	201-478-4185

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2021
Last Update Date	:	02/12/2026

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