Provider Demographics
NPI:1316004898
Name:MASLOW, ALBERT R (LCP LICENSED CLINICA)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:R
Last Name:MASLOW
Suffix:
Gender:M
Credentials:LCP LICENSED CLINICA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5694 SUGAR RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CROZET
Mailing Address - State:VA
Mailing Address - Zip Code:22932-2205
Mailing Address - Country:US
Mailing Address - Phone:434-823-2294
Mailing Address - Fax:
Practice Address - Street 1:914 E HIGH STREET
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-4850
Practice Address - Country:US
Practice Address - Phone:434-979-0276
Practice Address - Fax:434-979-1123
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001025103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA055403OtherANTHEM BCBS