MEDICARE: LSMAYNARD LLC

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	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R066358	OTHER	MD	MBON

General Provider Information

NPI Number	:	1518505544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LSMAYNARD LLC

Provider Business Mailing Address
First Line	:	4500 N PARK AVE STE N801
Second Line	:
City	:	CHEVY CHASE
State	:	MD
Zip	:	20815-7239
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 N PARK AVE STE N801
Second Line	:
City	:	CHEVY CHASE
State	:	MD
Zip	:	20815-7239
Country	:	US
Telephone Number	:	301-656-6605
Fax Number	:

Authorized Official
Title or Position	:	PH.D. CNS
Name	:	DR. STUART MAYNARD
Credential	:
Telephone Number	:	301-656-6605

Provider Enumeration Date	:	12/20/2019
Last Update Date	:	12/20/2019

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Directions to “LSMAYNARD LLC ” Practice Location

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