Provider Demographics
NPI:1588340525
Name:GWINN, MAGGIE (LMFT)
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:
Last Name:GWINN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 26TH ST STE 205
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90402-2543
Mailing Address - Country:US
Mailing Address - Phone:310-476-0109
Mailing Address - Fax:
Practice Address - Street 1:270 26TH ST STE 205
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90402-2543
Practice Address - Country:US
Practice Address - Phone:310-476-0109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC25533101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health