Provider Demographics
NPI:1609928571
Name:MAIURO, ROLAND D (PHD)
Entity Type:Individual
Prefix:
First Name:ROLAND
Middle Name:D
Last Name:MAIURO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 BOREN AVENUE
Mailing Address - Street 2:SUITE 1010
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104
Mailing Address - Country:US
Mailing Address - Phone:206-624-1856
Mailing Address - Fax:206-625-9475
Practice Address - Street 1:901 BOREN AVENUE
Practice Address - Street 2:SUITE 1010
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104
Practice Address - Country:US
Practice Address - Phone:206-624-1856
Practice Address - Fax:206-625-9475
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY0686103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical