Healthcare Provider Details

I. General information

NPI: 1255085924
Provider Name (Legal Business Name): MAXINE TAYLOR PHD, LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MAXINE TAYLOR PHD, LCSW-C

II. Dates (important events)

Enumeration Date: 02/10/2022
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10055 RED RUN BLVD
OWINGS MILLS MD
21117-4892
US

IV. Provider business mailing address

7611 CRAIN HWY SUITE C150, #124
UPPER MARLBORO MD
20772
US

V. Phone/Fax

Practice location:
  • Phone: 443-730-7954
  • Fax:
Mailing address:
  • Phone: 443-730-7954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23311
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: