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General NPI Number Information
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NPI Number | 1811850910
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Entity Type | Individual
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Provider Name | MAURICE KENYATA HARDISON
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Gender | Male
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Dates
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Enumeration Date | 12/05/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 1614 WEIRFIELD ST
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City | RIDGEWOOD
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State | NY
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Zip | 11385-5350
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Country | US
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Telephone | 718-456-7820
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Fax |
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Provider Business Mailing Address
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Address Line | 343 NEW YORK AVE APT 1R
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City | JERSEY CITY
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State | NJ
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Zip | 07307-1103
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Country | US
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Telephone | 646-753-0265
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 37174
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License Number State | NY
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