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NPI Code Detail

MEDICARE: JENNIFER R. MAIETTA

MEDICARE: JENNIFER R. MAIETTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerC004388NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134145428
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER R. MAIETTA
Provider Business Mailing Address
First Line : 736 SEDGEFIELD RD APT C
Second Line :
City : CHARLOTTE
State : NC
Zip : 28209-1274
Country : US
Telephone Number : 704-517-7366
Fax Number :
Provider Business Practice Location Address
First Line : 175 W FRANKLIN BLVD
Second Line :
City : GASTONIA
State : NC
Zip : 28052-4145
Country : US
Telephone Number : 704-517-7366
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2006
Last Update Date : 08/06/2012

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Directions to “ JENNIFER R. MAIETTA ” Practice Location

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