Healthcare Provider Details

I. General information

NPI: 1134828866
Provider Name (Legal Business Name): HASSAN AUGUSTIN MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2023
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 KNOLLCROFT RD BLDG 53
LYONS NJ
07939-5001
US

IV. Provider business mailing address

250 MOUNT VERNON PL APT 15J
NEWARK NJ
07106-3188
US

V. Phone/Fax

Practice location:
  • Phone: 908-647-0180
  • Fax:
Mailing address:
  • Phone: 908-656-7550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: