Provider Demographics
NPI:1104051267
Name:MAUL, DONNA
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:MAUL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 MAIN STREET
Mailing Address - Street 2:HEMPSTEAD COMMUNITY HEALTH CENTER
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550
Mailing Address - Country:US
Mailing Address - Phone:516-572-1300
Mailing Address - Fax:
Practice Address - Street 1:135 MAIN STREET
Practice Address - Street 2:HEMPSTEAD COMMUNITY HEALTH CENTER
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550
Practice Address - Country:US
Practice Address - Phone:516-572-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
02/09/1974OtherD.O.B