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Individual
MARIAH FOUNTAIN
Active
Individual
MARIAH FOUNTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
094322
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00355940
—
NY
01
—
1285628552
AGENCY
NY
01
—
WEV061
MEDICARE
NY
Enumeration date
09/29/2015
Last updated
04/05/2016
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