Provider Demographics
NPI:1114286564
Name:MAITLAND, ABBY UNDERWOOD (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:UNDERWOOD
Last Name:MAITLAND
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:374 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4031
Mailing Address - Country:US
Mailing Address - Phone:740-501-7362
Mailing Address - Fax:
Practice Address - Street 1:374 HICKORY ST
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4031
Practice Address - Country:US
Practice Address - Phone:740-501-7362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-04
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0854281041C0700X
OH07009351041C0700X
NJ44SC057458001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical