Provider Demographics
NPI:1134899149
Name:MAISEL, DONOVAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:DONOVAN
Middle Name:
Last Name:MAISEL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:DONOVAN
Other - Last Name:MAISEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:810 BESTGATE RD STE 325
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-4291
Mailing Address - Country:US
Mailing Address - Phone:443-906-3506
Mailing Address - Fax:
Practice Address - Street 1:810 BESTGATE RD STE 325
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-4291
Practice Address - Country:US
Practice Address - Phone:443-906-3506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06681103T00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist