MEDICARE: MAYA DENOLA MSW

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
1	104100000X	Social Worker	75670	CA
2	1041C0700X	Clinical Social Worker	97809	CA

General Provider Information

NPI Number	:	1437622164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYA DENOLA MSW

Provider Business Mailing Address
First Line	:	PO BOX 335
Second Line	:
City	:	SAN PEDRO
State	:	CA
Zip	:	90733-0335
Country	:	US
Telephone Number	:	510-708-9152
Fax Number	:

Provider Business Practice Location Address
First Line	:	816 S LELAND ST APT 6
Second Line	:
City	:	SAN PEDRO
State	:	CA
Zip	:	90731-2982
Country	:	US
Telephone Number	:	510-708-9152
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2019
Last Update Date	:	12/23/2020

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Directions to “ MAYA DENOLA MSW” Practice Location

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