Provider Demographics
NPI:1831213784
Name:DEAUGUSTINO, MARIA T (LPC)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:T
Last Name:DEAUGUSTINO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 STONEHOUSE LN
Mailing Address - Street 2:
Mailing Address - City:NEW WILMINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:16142-1623
Mailing Address - Country:US
Mailing Address - Phone:724-674-1594
Mailing Address - Fax:
Practice Address - Street 1:3143 MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:WEST MIDDLESEX
Practice Address - State:PA
Practice Address - Zip Code:16159-3419
Practice Address - Country:US
Practice Address - Phone:724-674-1594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC001064101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA110704OtherVALUE OPTIONS VENDOR NUMB
PA001308035OtherMANAGED CARE VENDOR NUMBE
PA001578297OtherKEYSTONE BLUE WEST