Provider Demographics
NPI:1457128001
Name:TAREQ, MAIMUNA
Entity Type:Individual
Prefix:
First Name:MAIMUNA
Middle Name:
Last Name:TAREQ
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 1:13 FAIRWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3005
Mailing Address - Country:US
Mailing Address - Phone:240-447-9376
Mailing Address - Fax:
Practice Address - Street 1:8701 GEORGIA AVE STE 411
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3713
Practice Address - Country:US
Practice Address - Phone:240-447-9376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGM998106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist