Provider Demographics
NPI:1144570953
Name:MAYNARD, DARREN WALDRON (LAC, CSMA)
Entity Type:Individual
Prefix:MR
First Name:DARREN
Middle Name:WALDRON
Last Name:MAYNARD
Suffix:
Gender:M
Credentials:LAC, CSMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 PINE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-4726
Mailing Address - Country:US
Mailing Address - Phone:802-324-3898
Mailing Address - Fax:
Practice Address - Street 1:431 PINE ST STE 201
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4726
Practice Address - Country:US
Practice Address - Phone:802-324-3898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004865171100000X
NJ25MZ00094000171100000X
VT091.0107964171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist