Healthcare Provider Details

I. General information

NPI: 1245135284
Provider Name (Legal Business Name): MANIFESTED BY MAURA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

116 IRONWOOD CT
ROSEDALE MD
21237-4071
US

IV. Provider business mailing address

116 IRONWOOD CT
ROSEDALE MD
21237-4071
US

V. Phone/Fax

Practice location:
  • Phone: 508-250-7990
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: MAURA MENDES-OXFORD
Title or Position: OWNER
Credential:
Phone: 508-250-7990