Healthcare Provider Details

I. General information

NPI: 1669206140
Provider Name (Legal Business Name): MAUREEN CARRON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2024
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 OVERLOOK AVE APT 5C
PEEKSKILL NY
10566-3014
US

IV. Provider business mailing address

150 OVERLOOK AVE APT 5C
PEEKSKILL NY
10566-3014
US

V. Phone/Fax

Practice location:
  • Phone: 914-642-6362
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number028729
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: