Provider Demographics
NPI:1164773537
Name:SMOLKIN, MAXINE C (LCSW-C)
Entity Type:Individual
Prefix:
First Name:MAXINE
Middle Name:C
Last Name:SMOLKIN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 PROFESSIONAL DR
Mailing Address - Street 2:SUITE 255
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3413
Mailing Address - Country:US
Mailing Address - Phone:240-683-6202
Mailing Address - Fax:240-683-6203
Practice Address - Street 1:610 PROFESSIONAL DR
Practice Address - Street 2:SUITE 255
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3413
Practice Address - Country:US
Practice Address - Phone:240-683-6202
Practice Address - Fax:240-683-6203
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD138391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD13839OtherMD LICENSE