MEDICARE: MISS LAURA SUZANNE MAXWELL BA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1386786879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LAURA SUZANNE MAXWELL BA

Provider Business Mailing Address
First Line	:	1860 OLD OKEECHOBEE RD
Second Line	:	SUITE 509
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-5253
Country	:	US
Telephone Number	:	561-683-4778
Fax Number	:	561-683-9995

Provider Business Practice Location Address
First Line	:	1860 OLD OKEECHOBEE RD
Second Line	:	SUITE 509
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-5253
Country	:	US
Telephone Number	:	561-683-4778
Fax Number	:	561-683-9995

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	07/09/2007

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