Provider Demographics
NPI:1144341561
Name:MAISH, KEMBA A (PH D)
Entity type:Individual
Prefix:DR
First Name:KEMBA
Middle Name:A
Last Name:MAISH
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4619 5TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-4737
Mailing Address - Country:US
Mailing Address - Phone:202-726-6017
Mailing Address - Fax:202-882-8169
Practice Address - Street 1:4619 5TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-4737
Practice Address - Country:US
Practice Address - Phone:202-882-8169
Practice Address - Fax:202-882-8169
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1319103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical