Provider Demographics
NPI:1992092670
Name:AUGUSTE, CANDYCE BURKE (PSYD)
Entity type:Individual
Prefix:DR
First Name:CANDYCE
Middle Name:BURKE
Last Name:AUGUSTE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 LIBERTY SQUARE
Mailing Address - Street 2:PMB #348
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-5800
Mailing Address - Country:US
Mailing Address - Phone:857-288-8841
Mailing Address - Fax:
Practice Address - Street 1:6 LIBERTY SQUARE
Practice Address - Street 2:PMB #348
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-5800
Practice Address - Country:US
Practice Address - Phone:857-288-8841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA11098103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health