Provider Demographics
NPI:1053501171
Name:ITALIANO, MAUREEN
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:
Last Name:ITALIANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 141280
Mailing Address - Street 2:HEARTLAND PSYCHOLOGICAL SERVICES PC
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314
Mailing Address - Country:US
Mailing Address - Phone:718-494-9397
Mailing Address - Fax:718-761-1000
Practice Address - Street 1:251 RICHMOND HILL ROAD
Practice Address - Street 2:HEARTLAND PSYCHOLOGICAL SERVICES PC
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314
Practice Address - Country:US
Practice Address - Phone:718-494-9397
Practice Address - Fax:718-761-1000
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0405311104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker