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General NPI Number Information
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NPI Number | 1326621806
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Entity Type | Individual
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Provider Name | HEATHER MAURO
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Gender | Female
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Dates
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Enumeration Date | 05/03/2021
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Last Update Date | 05/03/2021
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Provider Practice Location Address
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Address Line | 5111 W GENESEE ST
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City | CAMILLUS
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State | NY
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Zip | 13031-2357
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Country | US
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Telephone | 315-554-1694
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Fax |
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Provider Business Mailing Address
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Address Line | 159 SHETLAND PL
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City | WARNERS
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State | NY
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Zip | 13164-3705
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Country | US
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Telephone | 315-212-3337
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 091165-01
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License Number State | NY
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