Provider Demographics
NPI:1962782946
Name:MOBO, MARIA CORAZON (MA)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:CORAZON
Last Name:MOBO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:MA
Other - Middle Name:CORAZON
Other - Last Name:MOBO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:7228 243RD ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11362-2323
Mailing Address - Country:US
Mailing Address - Phone:718-819-8015
Mailing Address - Fax:
Practice Address - Street 1:7228 243RD ST
Practice Address - Street 2:
Practice Address - City:DOUGLASTON
Practice Address - State:NY
Practice Address - Zip Code:11362-2323
Practice Address - Country:US
Practice Address - Phone:718-819-8015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1118165103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst