Healthcare Provider Details

I. General information

NPI: 1316150667
Provider Name (Legal Business Name): MAUREEN THERESA MCGUIRE LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 11/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 WYNDHURST AVENUE. SUITE 300-E
BALTIMORE MD
21210
US

IV. Provider business mailing address

600 WYNDHURST AVENUE. SUITE 300-E
BALTIMORE MD
21210
US

V. Phone/Fax

Practice location:
  • Phone: 413-341-9161
  • Fax: 410-938-3410
Mailing address:
  • Phone: 413-341-9161
  • Fax: 410-938-3410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09824
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: