Healthcare Provider Details

I. General information

NPI: 1356885966
Provider Name (Legal Business Name): CYNTHIA DENISE MARITATO MSN,NP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2016
Last Update Date: 08/23/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 5TH AVE FL 11
NEW YORK NY
10001-8017
US

IV. Provider business mailing address

220 5TH AVE FL 11
NEW YORK NY
10001-8017
US

V. Phone/Fax

Practice location:
  • Phone: 272-446-0491
  • Fax: 718-498-3166
Mailing address:
  • Phone: 272-446-0491
  • Fax: 718-498-3166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10063596
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP017042
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number408945
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: