MEDICARE: A CENTER FOR WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	008366	NY

General Provider Information

NPI Number	:	1518108364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A CENTER FOR WELLNESS

Provider Business Mailing Address
First Line	:	451 FULTON AVE
Second Line	:	532
City	:	HEMPSTEAD
State	:	NY
Zip	:	11550-4102
Country	:	US
Telephone Number	:	516-538-2715
Fax Number	:	631-421-0959

Provider Business Practice Location Address
First Line	:	451 FULTON AVE
Second Line	:	532
City	:	HEMPSTEAD
State	:	NY
Zip	:	11550-4102
Country	:	US
Telephone Number	:	516-538-2715
Fax Number	:	631-421-0959

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. MARIA CIRILLO
Credential	:	PH.D.
Telephone Number	:	516-538-2715

Provider Enumeration Date	:	03/08/2009
Last Update Date	:	03/08/2009

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Directions to “A CENTER FOR WELLNESS ” Practice Location

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