Provider Demographics
NPI:1235258666
Name:TYSON, MAPLE JEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:MAPLE
Middle Name:JEAN
Last Name:TYSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43530 7TH ST E
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-4742
Mailing Address - Country:US
Mailing Address - Phone:818-832-7391
Mailing Address - Fax:
Practice Address - Street 1:43530 7TH ST E
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-4742
Practice Address - Country:US
Practice Address - Phone:818-832-7391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS234961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical