Provider Demographics
NPI:1093324121
Name:SUNDERLAND, MAYA E (LICSW)
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:E
Last Name:SUNDERLAND
Suffix:
Gender:
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 MAPLE AVE STE L04
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-3431
Mailing Address - Country:US
Mailing Address - Phone:401-646-9354
Mailing Address - Fax:508-676-1948
Practice Address - Street 1:310 MAPLE AVE STE L04
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806-3431
Practice Address - Country:US
Practice Address - Phone:401-646-9354
Practice Address - Fax:508-676-1948
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW043561041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical