MEDICARE: CHRYSTEN MAYDAK MSW, LCSWA

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	1041C0700X	Clinical Social Worker	P017091	NC

General Provider Information

NPI Number	:	1841914694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRYSTEN MAYDAK MSW, LCSWA

Provider Business Mailing Address
First Line	:	730 HAWTHORNE LN APT 335
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2170
Country	:	US
Telephone Number	:	814-490-8741
Fax Number	:

Provider Business Practice Location Address
First Line	:	1977 J N PEASE PL STE 204
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4527
Country	:	US
Telephone Number	:	919-617-1553
Fax Number	:

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

Provider Enumeration Date	:	09/26/2022
Last Update Date	:	02/23/2026

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