Healthcare Provider Details

I. General information

NPI: 1619347077
Provider Name (Legal Business Name): JOLENE N MAGGIO M.A., MHC-LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2015
Last Update Date: 09/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

669 CASTLETON AVE
STATEN ISLAND NY
10301-2028
US

IV. Provider business mailing address

669 CASTLETON AVE
STATEN ISLAND NY
10301-2028
US

V. Phone/Fax

Practice location:
  • Phone: 718-442-2225
  • Fax:
Mailing address:
  • Phone: 718-442-2225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: