Provider Demographics
NPI:1558899484
Name:CITRO, MARIA ANGELA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:ANGELA
Last Name:CITRO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:MARIA
Other - Middle Name:ANGELA
Other - Last Name:CITRO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:333 NORTH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-2300
Mailing Address - Country:US
Mailing Address - Phone:857-256-4388
Mailing Address - Fax:
Practice Address - Street 1:333 NORTH AVE STE A
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-2300
Practice Address - Country:US
Practice Address - Phone:857-256-4388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-23
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MA1232651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1558899484Medicaid