Basic Information
| Provider Information | |||||||||
| NPI: | 1184866782 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SACCIO | ||||||||
| FirstName: | MAUREEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LCSW, CASAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 W HAWTHORNE AVE | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | VALLEY STREAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115806223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5168729698 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 50 W HAWTHORNE AVE | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | VALLEY STREAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115806223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5168729698 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2009 | ||||||||
| LastUpdateDate: | 03/27/2009 | ||||||||
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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 | 101YA0400X | 9270 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 741 | 01 | NY | LICENSE # RO57715 | OTHER |