Provider Demographics
NPI:1902153042
Name:IBANEZ, MAUREEN ANN (MASPED)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:ANN
Last Name:IBANEZ
Suffix:
Gender:F
Credentials:MASPED
Other - Prefix:MISS
Other - First Name:MAUREEN
Other - Middle Name:ANN
Other - Last Name:BECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SPECIAL ED & ELEMENT
Mailing Address - Street 1:10A WEST DR
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-1433
Mailing Address - Country:US
Mailing Address - Phone:516-680-7762
Mailing Address - Fax:
Practice Address - Street 1:10A WEST DR
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-1433
Practice Address - Country:US
Practice Address - Phone:516-680-7762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMA SPED174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist