Provider Demographics
NPI:1811020647
Name:MAURICE, MAX (LGSW)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:
Last Name:MAURICE
Suffix:
Gender:M
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3604 13TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-1409
Mailing Address - Country:US
Mailing Address - Phone:202-536-8602
Mailing Address - Fax:
Practice Address - Street 1:1012 14TH ST NW
Practice Address - Street 2:SUITE 1000
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-3403
Practice Address - Country:US
Practice Address - Phone:202-737-2554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG500780241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical