MEDICARE: MAYA JEFFERSON

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	104100000X	Social Worker	24952	MD

General Provider Information

NPI Number	:	1952061319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYA JEFFERSON

Provider Business Mailing Address
First Line	:	2530 RIVA RD STE 312
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-7414
Country	:	US
Telephone Number	:	410-216-1701
Fax Number	:	443-458-7211

Provider Business Practice Location Address
First Line	:	2530 RIVA RD STE 312
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-7414
Country	:	US
Telephone Number	:	410-216-1701
Fax Number	:	443-458-7211

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

Provider Enumeration Date	:	12/28/2021
Last Update Date	:	12/28/2021

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Directions to “ MAYA JEFFERSON ” Practice Location

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