Provider Demographics
NPI:1689643439
Name:LANDRY, MAURA (LSCSW)
Entity Type:Individual
Prefix:
First Name:MAURA
Middle Name:
Last Name:LANDRY
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12428 246TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-7341
Mailing Address - Country:US
Mailing Address - Phone:785-840-5533
Mailing Address - Fax:
Practice Address - Street 1:12428 246TH ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-7341
Practice Address - Country:US
Practice Address - Phone:785-840-5533
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSR30545Medicare UPIN
KS070196Medicare ID - Type Unspecified