Provider Demographics
NPI:1730827056
Name:ITO, MAUREEN J
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:J
Last Name:ITO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:698 SEABROOK CT UNIT 204
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-7619
Mailing Address - Country:US
Mailing Address - Phone:954-865-8494
Mailing Address - Fax:
Practice Address - Street 1:698 SEABROOK CT UNIT 204
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-7619
Practice Address - Country:US
Practice Address - Phone:954-865-8494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool