Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003365552 |
---|---|
Provider Name | Andrew James Maag |
First Address | Marion, MA 02738-1003 |
Second Address | Marion, MA 02738-1003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2016 |
Last Update Date | 26/09/2016 |