Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 002888-1 | NY |
NPI | 1770954521 |
---|---|
Provider Name | Maureen Elizabeth Cronauer |
First Address | Utica, NY 13502-3854 |
Second Address | Utica, NY 13502-3854 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2015 |
Last Update Date | 19/10/2015 |