Provider Demographics
NPI:1487665972
Name:MAIDEN, JOSEPH RUSSELL SR (LICSW)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:RUSSELL
Last Name:MAIDEN
Suffix:SR
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:9331 AYSCOUGH RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8676
Mailing Address - Country:US
Mailing Address - Phone:843-821-7291
Mailing Address - Fax:
Practice Address - Street 1:204 W HILL BLVD
Practice Address - Street 2:437 MEDICAL OPERATIONS SQUADRON
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29404
Practice Address - Country:US
Practice Address - Phone:843-963-6972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3027071041C0700X
MD085371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical