Provider Demographics
NPI:1164518148
Name:VOLLARO, MAUREEN (LCSW)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:VOLLARO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:
Other - Last Name:RYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:1461 LAKELAND AVE
Mailing Address - Street 2:SUITE 12
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-2174
Mailing Address - Country:US
Mailing Address - Phone:631-742-8729
Mailing Address - Fax:631-732-0355
Practice Address - Street 1:1461 LAKELAND AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-2174
Practice Address - Country:US
Practice Address - Phone:631-742-8729
Practice Address - Fax:631-732-0355
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0564051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN2K631Medicare ID - Type Unspecified