Provider Demographics
NPI:1306322763
Name:MAURO, CAROL M
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:M
Last Name:MAURO
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 1:59A BALCOM RD
Mailing Address - Street 2:
Mailing Address - City:FOSTER
Mailing Address - State:RI
Mailing Address - Zip Code:02825-1324
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:181 HOWARD HILL RD
Practice Address - Street 2:
Practice Address - City:FOSTER
Practice Address - State:RI
Practice Address - Zip Code:02825-1226
Practice Address - Country:US
Practice Address - Phone:401-392-9208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106737104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
05-6000153OtherFEDERAL