Provider Demographics
NPI:1003365552
Name:MAAG, ANDREW JAMES
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JAMES
Last Name:MAAG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 ICHABOD LN
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:MA
Mailing Address - Zip Code:02738-1003
Mailing Address - Country:US
Mailing Address - Phone:857-939-1653
Mailing Address - Fax:
Practice Address - Street 1:49 ICHABOD LN
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:MA
Practice Address - Zip Code:02738-1003
Practice Address - Country:US
Practice Address - Phone:857-939-1653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor