Healthcare Provider Details

I. General information

NPI: 1598513970
Provider Name (Legal Business Name): AMY MAISTERRA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2024
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 WISCONSIN AVE # 1196
CHEVY CHASE MD
20815-6105
US

IV. Provider business mailing address

6800 WISCONSIN AVE # 1196
CHEVY CHASE MD
20815-6105
US

V. Phone/Fax

Practice location:
  • Phone: 240-244-9234
  • Fax:
Mailing address:
  • Phone: 240-244-9234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06516000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904017825
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number32933
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC200003318
License Number StateDC
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW014936
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: