Basic Information
Provider Information
NPI: 1003141219
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MAUN
FirstName: LETITIA
MiddleName: LOUISE
NamePrefix: MS.
NameSuffix:  
Credential: M.A.., M.ED, LMSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 161 W 54TH ST
Address2:  
City: NEW YORK
State: NY
PostalCode: 100195322
CountryCode: US
TelephoneNumber: 9175664068
FaxNumber:  
Practice Location
Address1: 161 W 54TH ST
Address2:  
City: NEW YORK
State: NY
PostalCode: 100195322
CountryCode: US
TelephoneNumber: 9175664068
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/05/2009
LastUpdateDate: 10/05/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X6304299NYY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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