Provider Demographics
NPI:1003960915
Name:UNDERWOOD, MAUREEN IDA (MSW)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:IDA
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096
Mailing Address - Country:US
Mailing Address - Phone:856-906-5101
Mailing Address - Fax:
Practice Address - Street 1:2005 KINGS HWY
Practice Address - Street 2:
Practice Address - City:SWEDESBORO
Practice Address - State:NJ
Practice Address - Zip Code:08085-3217
Practice Address - Country:US
Practice Address - Phone:856-906-5101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05168700101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health