Provider Demographics
NPI:1265838809
Name:MARAH, MAIMUNAH (MSED, LCCE)
Entity Type:Individual
Prefix:MRS
First Name:MAIMUNAH
Middle Name:
Last Name:MARAH
Suffix:
Gender:F
Credentials:MSED, LCCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11474 CONNECTICUT AVE
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-1305
Mailing Address - Country:US
Mailing Address - Phone:202-630-5403
Mailing Address - Fax:
Practice Address - Street 1:11474 CONNECTICUT AVE
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-1305
Practice Address - Country:US
Practice Address - Phone:202-630-5403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD4365222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist