Provider Demographics
NPI:1669816690
Name:MAURO, MARIA (MSED)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MAURO
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 PAINE ST
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-1231
Mailing Address - Country:US
Mailing Address - Phone:631-275-1357
Mailing Address - Fax:
Practice Address - Street 1:25 PAINE ST
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-1231
Practice Address - Country:US
Practice Address - Phone:631-275-1357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-21
Last Update Date:2013-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY723712131174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist