Provider Demographics
NPI:1518082007
Name:GEMIGNANI, MAIA G (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:MAIA
Middle Name:G
Last Name:GEMIGNANI
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 1:10846 GAMBRILL PARK RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-1618
Mailing Address - Country:US
Mailing Address - Phone:240-422-5111
Mailing Address - Fax:301-668-9110
Practice Address - Street 1:256 W PATRICK ST
Practice Address - Street 2:SUITE 3
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6907
Practice Address - Country:US
Practice Address - Phone:240-422-5111
Practice Address - Fax:301-668-9110
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD117871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical