MEDICARE: DR. KEMBA A. MAISH PH. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	1319	DC

General Provider Information

NPI Number	:	1144341561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEMBA A. MAISH PH. D.

Provider Business Mailing Address
First Line	:	4619 5TH ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-4737
Country	:	US
Telephone Number	:	202-726-6017
Fax Number	:	202-882-8169

Provider Business Practice Location Address
First Line	:	4619 5TH ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-4737
Country	:	US
Telephone Number	:	202-882-8169
Fax Number	:	202-882-8169

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	07/08/2007

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