Provider Demographics
NPI:1497222434
Name:MAUREEN VOLLARO LCSW PC
Entity Type:Organization
Organization Name:MAUREEN VOLLARO LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLLARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-732-4794
Mailing Address - Street 1:1461 LAKELAND AVE UNIT 12
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-2174
Mailing Address - Country:US
Mailing Address - Phone:631-732-4794
Mailing Address - Fax:631-732-0355
Practice Address - Street 1:16 CYPRESS CT
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-3050
Practice Address - Country:US
Practice Address - Phone:631-742-8729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)