Provider Demographics
NPI:1538235585
Name:AUGUSTUS, DENNIS LEON (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:LEON
Last Name:AUGUSTUS
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17329 COLT DR
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-8647
Mailing Address - Country:US
Mailing Address - Phone:208-459-8088
Mailing Address - Fax:208-459-1552
Practice Address - Street 1:17329 COLT DR
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83607-8647
Practice Address - Country:US
Practice Address - Phone:208-459-8088
Practice Address - Fax:208-459-1552
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW 14331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1692682Medicare ID - Type Unspecified