Provider Demographics
NPI:1063176519
Name:LUSIGNAN, AUBREY
Entity type:Individual
Prefix:
First Name:AUBREY
Middle Name:
Last Name:LUSIGNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 KNICKERBOCKER AVE APT 1F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-5327
Mailing Address - Country:US
Mailing Address - Phone:401-440-2938
Mailing Address - Fax:
Practice Address - Street 1:667 KNICKERBOCKER AVE APT 1F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-5327
Practice Address - Country:US
Practice Address - Phone:401-440-2938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011672101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health