Provider Demographics
NPI: | 1518505544 |
---|---|
Name: | LSMAYNARD LLC |
Entity Type: | Organization |
Organization Name: | LSMAYNARD LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PH.D. CNS |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | STUART |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MAYNARD |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 301-656-6605 |
Mailing Address - Street 1: | 4500 N PARK AVE STE N801 |
Mailing Address - Street 2: | |
Mailing Address - City: | CHEVY CHASE |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 20815-7239 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4500 N PARK AVE STE N801 |
Practice Address - Street 2: | |
Practice Address - City: | CHEVY CHASE |
Practice Address - State: | MD |
Practice Address - Zip Code: | 20815-7239 |
Practice Address - Country: | US |
Practice Address - Phone: | 301-656-6605 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-12-20 |
Last Update Date: | 2019-12-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 163WP0809X | Nursing Service Providers | Registered Nurse | Psychiatric/Mental Health, Adult | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MD | R066358 | Other | MBON |