Provider Demographics
NPI:1215963624
Name:AUGUSTO, FERNANDO (PHD)
Entity type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:
Last Name:AUGUSTO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 251
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:MA
Mailing Address - Zip Code:02726-0251
Mailing Address - Country:US
Mailing Address - Phone:401-621-5351
Mailing Address - Fax:401-621-5351
Practice Address - Street 1:184 WATERMAN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4051
Practice Address - Country:US
Practice Address - Phone:401-621-5351
Practice Address - Fax:401-621-5351
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00686103TC0700X
MA4203103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI629006069Medicare PIN