Provider Demographics
NPI:1952061319
Name:JEFFERSON, MAYA
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 RIVA RD STE 312
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7414
Mailing Address - Country:US
Mailing Address - Phone:410-216-1701
Mailing Address - Fax:443-458-7211
Practice Address - Street 1:2530 RIVA RD STE 312
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7414
Practice Address - Country:US
Practice Address - Phone:410-216-1701
Practice Address - Fax:443-458-7211
Is Sole Proprietor?:No
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24952104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker