Individual
MARIE-LUCILE MAUBOUSSIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LMSW
Contact information
Practice address
501 MITCHELL ST, ITHACA, NY 14850-6148
(607) 277-3062
Mailing address
10 WOODCREST AVE, ITHACA, NY 14850-6222
(607) 227-3326
Taxonomy
Speciality
Code
Description
License number
State
1041S0200X
School Social Worker
Primary
048261-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7379617
NEW YORK STATE OFFICE OF REGISTRATION CERTIFICATE
NY
Enumeration date
05/16/2012
Last updated
05/16/2012
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