Healthcare Provider Details

I. General information

NPI: 1679052575
Provider Name (Legal Business Name): JACQUELINE CHRISTINA MAURO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2018
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1622 CENTRAL AVE
FAR ROCKAWAY NY
11691-4002
US

IV. Provider business mailing address

855 E BROADWAY APT 3C
LONG BEACH NY
11561-4747
US

V. Phone/Fax

Practice location:
  • Phone: 718-327-9001
  • Fax:
Mailing address:
  • Phone: 516-761-5845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number105535
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number105535
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number101656
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: