Provider Demographics
NPI:1902246267
Name:MAYNIGO, PACITA (PSYD)
Entity Type:Individual
Prefix:
First Name:PACITA
Middle Name:
Last Name:MAYNIGO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:
Other - Last Name:MAYNIGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:352 7TH AVE
Mailing Address - Street 2:SUITE 1005
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-5012
Mailing Address - Country:US
Mailing Address - Phone:347-413-1852
Mailing Address - Fax:
Practice Address - Street 1:352 7TH AVE
Practice Address - Street 2:SUITE 1005
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5012
Practice Address - Country:US
Practice Address - Phone:347-413-1852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health