Provider Demographics
NPI:1972664506
Name:MAURO, CAROLE IRENE (SOCIAL WORKER)
Entity Type:Individual
Prefix:MS
First Name:CAROLE
Middle Name:IRENE
Last Name:MAURO
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 EDEN AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-3220
Mailing Address - Country:US
Mailing Address - Phone:516-798-6359
Mailing Address - Fax:516-798-6359
Practice Address - Street 1:105 EDEN AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-3220
Practice Address - Country:US
Practice Address - Phone:516-798-6359
Practice Address - Fax:516-798-6359
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR033380-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN812V1Medicare ID - Type Unspecified