Provider Demographics
NPI:1205487816
Name:SMALL, MAGGIE WONSON
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:WONSON
Last Name:SMALL
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 1:22 BURPEE RD
Mailing Address - Street 2:
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-1736
Mailing Address - Country:US
Mailing Address - Phone:781-910-5671
Mailing Address - Fax:
Practice Address - Street 1:43 DARTMOUTH ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-5103
Practice Address - Country:US
Practice Address - Phone:781-306-4820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor