Provider Demographics
NPI:1952579302
Name:MAEROV, LINDA MARIE
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MARIE
Last Name:MAEROV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:MARIE
Other - Last Name:MAEROV
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, MBA
Mailing Address - Street 1:2 FECAMP
Mailing Address - Street 2:
Mailing Address - City:NEWPORT COAST
Mailing Address - State:CA
Mailing Address - Zip Code:92657-1045
Mailing Address - Country:US
Mailing Address - Phone:949-610-9915
Mailing Address - Fax:
Practice Address - Street 1:220 NEWPORT CENTER DR STE 1
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-610-9915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27097104100000X, 1041C0700X
NY075543104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical