Basic Information
| Provider Information | |||||||||
| NPI: | 1003153263 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LIGUORI | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | CRISTINA | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 770 GRAND BLVD | ||||||||
| Address2: | SUITE 17 | ||||||||
| City: | DEER PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117295750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6313924357 | ||||||||
| FaxNumber: | 6313924358 | ||||||||
| Practice Location | |||||||||
| Address1: | 770 GRAND BLVD | ||||||||
| Address2: | SUITE 17 | ||||||||
| City: | DEER PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117295750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6313924357 | ||||||||
| FaxNumber: | 6313924358 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2013 | ||||||||
| LastUpdateDate: | 12/05/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 088033 | NY | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 084501 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.