MEDICARE: JESSICA LOUISA MAURO I

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	103K00000X	NY

General Provider Information

NPI Number	:	1376315119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LOUISA MAURO I

Provider Business Mailing Address
First Line	:	2619 BELMILL RD
Second Line	:
City	:	BELLMORE
State	:	NY
Zip	:	11710-4512
Country	:	US
Telephone Number	:	516-244-9169
Fax Number	:

Provider Business Practice Location Address
First Line	:	2619 BELMILL RD
Second Line	:
City	:	BELLMORE
State	:	NY
Zip	:	11710-4512
Country	:	US
Telephone Number	:	516-244-9169
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2023
Last Update Date	:	10/25/2023

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