Provider Demographics
NPI:1861576555
Name:MAYER, MAUREEN FARA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:FARA
Last Name:MAYER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 E PARHAM RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-1126
Mailing Address - Country:US
Mailing Address - Phone:804-553-9401
Mailing Address - Fax:804-553-9403
Practice Address - Street 1:827 E PARHAM RD
Practice Address - Street 2:SUITE 2
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-1126
Practice Address - Country:US
Practice Address - Phone:804-553-9401
Practice Address - Fax:804-553-9403
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA14001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA089996OtherSOUTHERN HEALTH
VA195588OtherANTHEM COLONIAL HEIGHTS#
VA195589OtherANTHEM RICHMOND#