Healthcare Provider Details

I. General information

NPI: 1164283727
Provider Name (Legal Business Name): KIERSTEN MAULE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 01/22/2024
Certification Date: 01/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 GROVE NECK RD
EARLEVILLE MD
21919-3008
US

IV. Provider business mailing address

2705 PEBBLE BEACH DR
ELKTON MD
21921-6479
US

V. Phone/Fax

Practice location:
  • Phone: 410-275-6200
  • Fax:
Mailing address:
  • Phone: 443-567-1158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number30220
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: