Basic Information
| Provider Information | |||||||||
| NPI: | 1790024081 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAURO | ||||||||
| FirstName: | KARA | ||||||||
| MiddleName: | ANN | ||||||||
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| NameSuffix: | |||||||||
| Credential: | MHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 LAFAYETTE AVE | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112161020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184759407 | ||||||||
| FaxNumber: | 7184839287 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 LAFAYETTE AVE | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112161020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184759407 | ||||||||
| FaxNumber: | 7184839287 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2013 | ||||||||
| LastUpdateDate: | 02/06/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | P80303 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 03505424 | 05 | NY | MEDICAID |