Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003013772 |
---|---|
Provider Name | Mrs. Agustina Fougere |
First Address | Brooklyn, NY 11222-3930 |
Second Address | Brooklyn, NY 11217-2812 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2007 |
Last Update Date | 08/07/2007 |