Provider Demographics
NPI:1104188804
Name:STARK, MAUREEN ANNE (MSED)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:ANNE
Last Name:STARK
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:MS
Other - First Name:MAUREEN
Other - Middle Name:A
Other - Last Name:MORONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3207 RONIT CT
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-1933
Mailing Address - Country:US
Mailing Address - Phone:914-438-3133
Mailing Address - Fax:
Practice Address - Street 1:3207 RONIT CT
Practice Address - Street 2:
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-1933
Practice Address - Country:US
Practice Address - Phone:914-438-3133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-09
Last Update Date:2012-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist