Healthcare Provider Details

I. General information

NPI: 1013305408
Provider Name (Legal Business Name): JOANNA MAULBECK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JO MAULBECK LCSW

II. Dates (important events)

Enumeration Date: 01/07/2015
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 AVENUE OF THE AMERICAS FL 3
NEW YORK NY
10013-1594
US

IV. Provider business mailing address

13 PELHAM RD
LEXINGTON MA
02421-5707
US

V. Phone/Fax

Practice location:
  • Phone: 212-941-9090
  • Fax:
Mailing address:
  • Phone: 781-274-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: