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NPI Code Detail

MEDICARE: RANDOLPH AUGUSTEEN JR DESTIN LMHC

MEDICARE: RANDOLPH AUGUSTEEN JR DESTIN LMHC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor17516NY
2101YM0800XMental Health Counselor016841-01NY

General Provider Information

NPI Number : 1679010938
Entity Type Code : Individual
Provider Name (Legal Business Name) : RANDOLPH AUGUSTEEN JR DESTIN LMHC
Provider Business Mailing Address
First Line : 1910 ARTHUR AVE
Second Line :
City : BRONX
State : NY
Zip : 10457-6305
Country : US
Telephone Number : 718-466-8438
Fax Number : 718-731-2453
Provider Business Practice Location Address
First Line : 1910 ARTHUR AVE
Second Line :
City : BRONX
State : NY
Zip : 10457-6305
Country : US
Telephone Number : 718-466-8438
Fax Number : 718-731-2453
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2017
Last Update Date : 01/21/2026

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