Healthcare Provider Details

I. General information

NPI: 1558163667
Provider Name (Legal Business Name): JOSEPH MAXWELL MARON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 W LANCASTER AVE STE 2
BRYN MAWR PA
19010-3220
US

IV. Provider business mailing address

850 W LANCASTER AVE STE 2
BRYN MAWR PA
19010-3220
US

V. Phone/Fax

Practice location:
  • Phone: 610-520-1510
  • Fax:
Mailing address:
  • Phone: 610-520-1510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC017785
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: