Provider Demographics
NPI:1770235277
Name:KSOR, MARIA GORATY
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:GORATY
Last Name:KSOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 JUSTIN DR NW APT 33
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4422
Mailing Address - Country:US
Mailing Address - Phone:505-803-9435
Mailing Address - Fax:
Practice Address - Street 1:5350 JUSTIN DR NW APT 33
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-4422
Practice Address - Country:US
Practice Address - Phone:505-803-9435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician