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Individual
MARIA T DEAUGUSTINO
Active
Individual
MARIA T DEAUGUSTINO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
PC001064
PA
101YP2500X
Professional Counselor
Primary
PC001064
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001308035
MANAGED CARE VENDOR NUMBE
PA
01
—
001578297
KEYSTONE BLUE WEST
PA
01
—
110704
VALUE OPTIONS VENDOR NUMB
PA
Enumeration date
03/18/2007
Last updated
03/23/2021
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