Provider Demographics
NPI:1841452901
Name:CONKLIN, MARIA G (LAC, MA)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:G
Last Name:CONKLIN
Suffix:
Gender:F
Credentials:LAC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12021 SW LAGUNA BAY PKWY
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-7755
Mailing Address - Country:US
Mailing Address - Phone:908-227-6302
Mailing Address - Fax:
Practice Address - Street 1:12021 SW LAGUNA BAY PKWY
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-7755
Practice Address - Country:US
Practice Address - Phone:908-227-6302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00043200101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor