Provider Demographics
NPI:1427379866
Name:MAPLE, SHANNON STAFFORD HERMAN (LCSW-C)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:STAFFORD HERMAN
Last Name:MAPLE
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 1:2107 LAUREL BUSH RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6181
Mailing Address - Country:US
Mailing Address - Phone:443-827-3463
Mailing Address - Fax:
Practice Address - Street 1:2107 LAUREL BUSH RD
Practice Address - Street 2:SUITE 209
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-6181
Practice Address - Country:US
Practice Address - Phone:443-827-3463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG13000104100000X
MD176351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker