Provider Demographics
NPI:1447682638
Name:MAULEON, VICTORIA A (MSED)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:A
Last Name:MAULEON
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:A
Other - Last Name:BOTTSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED
Mailing Address - Street 1:18 TOWNE LN
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-2825
Mailing Address - Country:US
Mailing Address - Phone:516-983-2643
Mailing Address - Fax:
Practice Address - Street 1:18 TOWNE LN
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-2825
Practice Address - Country:US
Practice Address - Phone:516-983-2643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst