Provider Demographics
NPI:1235914540
Name:MAGGIE EMBICK LCSW LLC
Entity Type:Organization
Organization Name:MAGGIE EMBICK LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:EMBICK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, RDT
Authorized Official - Phone:312-883-3996
Mailing Address - Street 1:412A MALUNIU AVE
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-5815
Mailing Address - Country:US
Mailing Address - Phone:312-883-3996
Mailing Address - Fax:
Practice Address - Street 1:412A MALUNIU AVE
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-5815
Practice Address - Country:US
Practice Address - Phone:312-883-3996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)