Provider Demographics
NPI:1417561911
Name:CENTENO, MARICAR (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:MARICAR
Middle Name:
Last Name:CENTENO
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 MAYFLOWER LN
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3303
Mailing Address - Country:US
Mailing Address - Phone:646-427-0555
Mailing Address - Fax:
Practice Address - Street 1:37 MAYFLOWER LN
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3303
Practice Address - Country:US
Practice Address - Phone:646-427-0555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017830225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist