Healthcare Provider Details

I. General information

NPI: 1518505544
Provider Name (Legal Business Name): LSMAYNARD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2019
Last Update Date: 12/20/2019
Certification Date: 12/20/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 N PARK AVE STE N801
CHEVY CHASE MD
20815-7239
US

IV. Provider business mailing address

4500 N PARK AVE STE N801
CHEVY CHASE MD
20815-7239
US

V. Phone/Fax

Practice location:
  • Phone: 301-656-6605
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: DR. STUART MAYNARD
Title or Position: PH.D. CNS
Credential:
Phone: 301-656-6605