MEDICARE: DR. CAROL T. MAXFIELD PH.D

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	103G00000X	Clinical Neuropsychologist	011351	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447320700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROL T. MAXFIELD PH.D

Provider Business Mailing Address
First Line	:	PO BOX 221
Second Line	:
City	:	GREAT BARRINGTON
State	:	MA
Zip	:	01230-0221
Country	:	US
Telephone Number	:	917-655-0533
Fax Number	:	413-528-6170

Provider Business Practice Location Address
First Line	:	115 E 9TH ST
Second Line	:	APT 2E
City	:	NEW YORK
State	:	NY
Zip	:	10003-5414
Country	:	US
Telephone Number	:	917-655-0533
Fax Number	:	413-528-6170

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

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	07/09/2007

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