Provider Demographics
NPI:1700473535
Name:HARRIOTT, MAUREEN L
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:L
Last Name:HARRIOTT
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 1:3360 BAYCHESTER AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-1514
Mailing Address - Country:US
Mailing Address - Phone:917-603-2038
Mailing Address - Fax:
Practice Address - Street 1:460 SOUTH 10TH STREET
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550
Practice Address - Country:US
Practice Address - Phone:914-217-2160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019610-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist