Provider Demographics
NPI:1063216190
Name:ANGUSTIA, MOISES (MHC-L)
Entity type:Individual
Prefix:
First Name:MOISES
Middle Name:
Last Name:ANGUSTIA
Suffix:
Gender:
Credentials:MHC-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 LAWRENCE ST FL 5
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5240
Mailing Address - Country:US
Mailing Address - Phone:917-202-6630
Mailing Address - Fax:917-202-6630
Practice Address - Street 1:27 LILAC LN
Practice Address - Street 2:
Practice Address - City:RIDGE
Practice Address - State:NY
Practice Address - Zip Code:11961-3132
Practice Address - Country:US
Practice Address - Phone:917-202-6630
Practice Address - Fax:917-202-6630
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP133436101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty