Provider Demographics
NPI:1790115764
Name:HENNINGER, MAURA C (ND)
Entity type:Individual
Prefix:DR
First Name:MAURA
Middle Name:C
Last Name:HENNINGER
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:487 WEST END AVENUE
Mailing Address - Street 2:APT. 4B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024
Mailing Address - Country:US
Mailing Address - Phone:917-822-0617
Mailing Address - Fax:646-360-2844
Practice Address - Street 1:5 SYLVAN ROAD SOUTH
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880
Practice Address - Country:US
Practice Address - Phone:203-307-5788
Practice Address - Fax:203-307-5788
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT475175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath