Provider Demographics
NPI: | 1497232433 |
---|---|
Name: | JOSEPH A. MARAVI, LLC |
Entity Type: | Organization |
Organization Name: | JOSEPH A. MARAVI, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | JOSEPH |
Authorized Official - Middle Name: | ARI |
Authorized Official - Last Name: | MARAVI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LCSW-C |
Authorized Official - Phone: | 443-831-9001 |
Mailing Address - Street 1: | 6486 ONWARD TRL |
Mailing Address - Street 2: | |
Mailing Address - City: | CLARKSVILLE |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 21029-1282 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 443-831-9001 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 585 MAIN ST STE 143 |
Practice Address - Street 2: | |
Practice Address - City: | LAUREL |
Practice Address - State: | MD |
Practice Address - Zip Code: | 20707-4354 |
Practice Address - Country: | US |
Practice Address - Phone: | 301-490-0778 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-07-23 |
Last Update Date: | 2018-07-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MD | 07383 | 1041C0700X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Single Specialty |