Provider Demographics
NPI:1841937604
Name:MAITLAND, LUDEAN NAOMI (LMSW)
Entity type:Individual
Prefix:
First Name:LUDEAN
Middle Name:NAOMI
Last Name:MAITLAND
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 EASTERN PKWY APT 8A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-5239
Mailing Address - Country:US
Mailing Address - Phone:347-712-8612
Mailing Address - Fax:
Practice Address - Street 1:1315 EASTERN PKWY APT 8A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-5239
Practice Address - Country:US
Practice Address - Phone:347-712-8612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-13
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY107257-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY107257-01OtherLMSW, NY