Augustine, Mark William

Augustine, Mark William is an sole proprietor health care provider with primary practice located at 70 Pine St , Waterbury CT 06710-2169. He recently has only one registered license in Behavioral Health & Social Service Providers / Marriage & Family Therapist, which is considered as his primary health care specialty. Augustine, Mark William can be contacted via phone (203) 756-7287.

Contact Information

Primary practice address
70 Pine St Waterbury CT 06710-2169
Phone: (203) 756-7287
Fax: (203) 596-2789
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Marriage & Family Therapist 106H00000X CT000994 Connecticut

Profile Details

NPI number 1548349541
LBN Legal business name Augustine, Mark William
Credentials LMFT
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 2nd, 2006
Last updated Feb 18th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1548349541 NPPES
Connecticut MEDICAID 004242327

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