Provider Demographics
NPI:1003115148
Name:HEALY, MAURA A (LICSW)
Entity type:Individual
Prefix:MS
First Name:MAURA
Middle Name:A
Last Name:HEALY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1935 11TH ST NW
Mailing Address - Street 2:#2
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-4113
Mailing Address - Country:US
Mailing Address - Phone:202-483-1001
Mailing Address - Fax:
Practice Address - Street 1:1935 11TH ST NW
Practice Address - Street 2:#2
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-4113
Practice Address - Country:US
Practice Address - Phone:202-483-1001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500789821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCX645OtherBCBS