Healthcare Provider Details

I. General information

NPI: 1366765935
Provider Name (Legal Business Name): MAPLE CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2010
Last Update Date: 03/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5623 MILLS FIELD LN
PORT REPUBLIC MD
20676-2067
US

IV. Provider business mailing address

5623 MILLS FIELD LN
PORT REPUBLIC MD
20676-2067
US

V. Phone/Fax

Practice location:
  • Phone: 410-586-8041
  • Fax:
Mailing address:
  • Phone: 410-586-8041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13078
License Number StateMD

VIII. Authorized Official

Name: DENISE MAPLE
Title or Position: PRINCIPAL CONSULTANT
Credential: LCSW-C
Phone: 410-586-8041