Provider Demographics
NPI:1912872722
Name:MAURO, NICHOLAS RAYMOND
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:RAYMOND
Last Name:MAURO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MANOR RD
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07514-1319
Mailing Address - Country:US
Mailing Address - Phone:862-600-2753
Mailing Address - Fax:403-800-2208
Practice Address - Street 1:8 MANOR RD
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514-1319
Practice Address - Country:US
Practice Address - Phone:862-600-2753
Practice Address - Fax:403-800-2208
Is Sole Proprietor?:No
Enumeration Date:2025-10-09
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101Y00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)