Provider Demographics
NPI:1235970575
Name:APOLLON, MARIAH (NBCC, LAC)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:APOLLON
Suffix:
Gender:F
Credentials:NBCC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 25
Mailing Address - Street 2:HIGHBRIDGE STATION
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-0025
Mailing Address - Country:US
Mailing Address - Phone:646-243-9439
Mailing Address - Fax:
Practice Address - Street 1:136 KINGSLAND RD STE 1034
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07014-1915
Practice Address - Country:US
Practice Address - Phone:646-243-9439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00705400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health