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General NPI Number Information
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NPI Number | 1831213784
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Entity Type | Individual
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Provider Name | MARIA T DEAUGUSTINO LPC
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Gender | Female
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Dates
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Enumeration Date | 03/18/2007
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Last Update Date | 03/23/2021
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Provider Practice Location Address
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Address Line | 3143 MAIN ST STE 3
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City | WEST MIDDLESEX
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State | PA
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Zip | 16159-3419
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Country | US
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Telephone | 724-674-1594
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Fax |
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Provider Business Mailing Address
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Address Line | 25 STONEHOUSE LN
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City | NEW WILMINGTON
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State | PA
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Zip | 16142-1623
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Country | US
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Telephone | 724-674-1594
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | PC001064
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC001064
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License Number State | PA
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