Provider Demographics
NPI:1295097392
Name:GIUDICE - MAFARO, ANGELA DIANE (MS, ED BCBA LBA)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:DIANE
Last Name:GIUDICE - MAFARO
Suffix:
Gender:F
Credentials:MS, ED BCBA LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 THORNYCROFT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-5138
Mailing Address - Country:US
Mailing Address - Phone:718-227-3891
Mailing Address - Fax:
Practice Address - Street 1:389 THORNYCROFT AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-5138
Practice Address - Country:US
Practice Address - Phone:718-227-3891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
NY003232103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist