Provider Demographics
NPI:1104141803
Name:AUGOSTINI, LORI VIRGINIA (NP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:VIRGINIA
Last Name:AUGOSTINI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 PAGE AVENUE
Mailing Address - Street 2:
Mailing Address - City:COHOES
Mailing Address - State:NY
Mailing Address - Zip Code:12047
Mailing Address - Country:US
Mailing Address - Phone:518-235-5059
Mailing Address - Fax:518-235-5029
Practice Address - Street 1:21 PAGE AVENUE
Practice Address - Street 2:CDPC- PAGE AVENUE CLINIC
Practice Address - City:COHOES
Practice Address - State:NY
Practice Address - Zip Code:12047
Practice Address - Country:US
Practice Address - Phone:518-235-5059
Practice Address - Fax:518-235-5029
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
NY401589363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health