Individual
MRS. MARIA MIDDENDORF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LCSW
Contact information
Practice address
5 VINE ST, CENTEREACH, NY 11720-1720
(631) 648-8206
(631) 648-8206
Mailing address
5 VINE ST, CENTEREACH, NY 11720-1720
(631) 648-8206
(631) 648-8206
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
080393-1
NY
252Y00000X
Early Intervention Provider Agency
Primary
—
NY
252Y00000X
Early Intervention Provider Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
W224351
—
NY
Enumeration date
09/30/2010
Last updated
01/08/2016
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