Healthcare Provider Details

I. General information

NPI: 1730692781
Provider Name (Legal Business Name): WENDY A MAURO MA, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2017
Last Update Date: 11/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

869 WHALLEY AVE
NEW HAVEN CT
06515-1728
US

IV. Provider business mailing address

120 CELANTANO DR
NAUGATUCK CT
06770-5215
US

V. Phone/Fax

Practice location:
  • Phone: 203-491-1652
  • Fax:
Mailing address:
  • Phone: 646-812-2637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number000136
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number000136
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: