Healthcare Provider Details

I. General information

NPI: 1588928170
Provider Name (Legal Business Name): MRS. JACLYN MASLATON-TARRAB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 04/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7701 13TH AVE
BROOKLYN NY
11228-2413
US

IV. Provider business mailing address

7701 13TH AVE
BROOKLYN NY
11228-2413
US

V. Phone/Fax

Practice location:
  • Phone: 718-232-1351
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: