Healthcare Provider Details

I. General information

NPI: 1063846343
Provider Name (Legal Business Name): MARIA LAURA FARRET LCAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2013
Last Update Date: 12/23/2023
Certification Date: 12/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

579 COURTLANDT AVE
BRONX NY
10451-5013
US

IV. Provider business mailing address

4711 48TH AVE
WOODSIDE NY
11377-6549
US

V. Phone/Fax

Practice location:
  • Phone: 718-485-2100
  • Fax: 718-485-2101
Mailing address:
  • Phone: 646-807-8041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number001945
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: