Provider Demographics
NPI:1699435842
Name:FLORES, MARIA MANNINO (MA, LCAT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:MANNINO
Last Name:FLORES
Suffix:
Gender:F
Credentials:MA, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 LINDEN BLVD APT 5H
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-3197
Mailing Address - Country:US
Mailing Address - Phone:646-258-9998
Mailing Address - Fax:
Practice Address - Street 1:58 LINDEN BLVD APT 5H
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-3197
Practice Address - Country:US
Practice Address - Phone:646-258-9998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002319221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist