Provider Demographics
NPI:1508965914
Name:MAILLE, BARBRARA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BARBRARA
Middle Name:
Last Name:MAILLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 ROBINSON WOODS
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-2061
Mailing Address - Country:US
Mailing Address - Phone:434-297-3160
Mailing Address - Fax:
Practice Address - Street 1:1008 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5328
Practice Address - Country:US
Practice Address - Phone:434-295-7711
Practice Address - Fax:434-296-0068
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040034221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA80001908Medicare ID - Type Unspecified