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NPI Code Detail

MEDICARE: MATTHEW MAYA LCSW

MEDICARE: MATTHEW 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
11041C0700XClinical Social Worker11526399-3501UT

General Provider Information

NPI Number : 1730878737
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW MAYA LCSW
Provider Business Mailing Address
First Line : 11175 S REDWOOD RD
Second Line :
City : SOUTH JORDAN
State : UT
Zip : 84095-8208
Country : US
Telephone Number : 801-699-1759
Fax Number : 801-931-2173
Provider Business Practice Location Address
First Line : 11175 S REDWOOD RD
Second Line :
City : SOUTH JORDAN
State : UT
Zip : 84095-8208
Country : US
Telephone Number : 801-699-1759
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2023
Last Update Date : 01/05/2026

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