Provider Demographics
NPI:1154915387
Name:MAURO, MATTHEW HALE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:HALE
Last Name:MAURO
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 MUSTANG CT
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1133
Mailing Address - Country:US
Mailing Address - Phone:443-845-4269
Mailing Address - Fax:
Practice Address - Street 1:206 MUSTANG CT
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1133
Practice Address - Country:US
Practice Address - Phone:443-845-4269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-28
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR1954032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty