MEDICARE: GENEVA MAYA LCSW

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	22005	TX

General Provider Information

NPI Number	:	1699932723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENEVA MAYA LCSW

Provider Business Mailing Address
First Line	:	PO BOX 841969
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-1969
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4410 NAVIGATION BLVD
Second Line	:	SUITE 278
City	:	HOUSTON
State	:	TX
Zip	:	77011-1036
Country	:	US
Telephone Number	:	713-547-8282
Fax Number	:

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

Provider Enumeration Date	:	05/16/2008
Last Update Date	:	05/16/2008

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Directions to “ GENEVA MAYA LCSW” Practice Location

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