Provider Demographics
NPI:1518108364
Name:A CENTER FOR WELLNESS
Entity Type:Organization
Organization Name:A CENTER FOR WELLNESS
Other - Org Name:MARIA CIRILLO
Other - Org Type:Other Name
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CIRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:516-538-2715
Mailing Address - Street 1:451 FULTON AVE
Mailing Address - Street 2:532
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-4102
Mailing Address - Country:US
Mailing Address - Phone:516-538-2715
Mailing Address - Fax:631-421-0959
Practice Address - Street 1:451 FULTON AVE
Practice Address - Street 2:532
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-4102
Practice Address - Country:US
Practice Address - Phone:516-538-2715
Practice Address - Fax:631-421-0959
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-08
Last Update Date:2009-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008366103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty