Provider Demographics
NPI:1760210397
Name:AUSTIN, MAX (MHC)
Entity type:Individual
Prefix:
First Name:MAX
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 NORTHWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:HALESITE
Mailing Address - State:NY
Mailing Address - Zip Code:11743-1339
Mailing Address - Country:US
Mailing Address - Phone:631-241-3969
Mailing Address - Fax:
Practice Address - Street 1:2075 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-3238
Practice Address - Country:US
Practice Address - Phone:631-351-7112
Practice Address - Fax:631-351-0862
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)