Provider Demographics
NPI:1013693944
Name:MAHER, JOAN (CNS,LDN)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:MAHER
Suffix:
Gender:F
Credentials:CNS,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5406 PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737
Mailing Address - Country:US
Mailing Address - Phone:508-904-2557
Mailing Address - Fax:
Practice Address - Street 1:5406 PATTERSON ST
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737
Practice Address - Country:US
Practice Address - Phone:508-904-2557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX5080133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist