Provider Demographics
NPI:1306227194
Name:PRIVATERA, MAUREEN JENNIFER (LMHC)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:JENNIFER
Last Name:PRIVATERA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:LE ROY
Mailing Address - State:NY
Mailing Address - Zip Code:14482-1381
Mailing Address - Country:US
Mailing Address - Phone:585-768-4655
Mailing Address - Fax:585-768-4655
Practice Address - Street 1:106 MUNSON STREET
Practice Address - Street 2:
Practice Address - City:LEROY
Practice Address - State:NY
Practice Address - Zip Code:14482
Practice Address - Country:US
Practice Address - Phone:585-768-4655
Practice Address - Fax:585-768-4655
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7753101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health