Provider Demographics
NPI:1164170593
Name:LAUB, MAEGEN L (LMSW)
Entity Type:Individual
Prefix:
First Name:MAEGEN
Middle Name:L
Last Name:LAUB
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27735 E MOCKINGBIRD DR
Mailing Address - Street 2:
Mailing Address - City:FLAT ROCK
Mailing Address - State:MI
Mailing Address - Zip Code:48134-4704
Mailing Address - Country:US
Mailing Address - Phone:734-752-7386
Mailing Address - Fax:
Practice Address - Street 1:27735 E MOCKINGBIRD DR
Practice Address - Street 2:
Practice Address - City:FLAT ROCK
Practice Address - State:MI
Practice Address - Zip Code:48134-4704
Practice Address - Country:US
Practice Address - Phone:734-752-7386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010974041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical