Healthcare Provider Details

I. General information

NPI: 1063409209
Provider Name (Legal Business Name): BARBARA J MAXSON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14001 N 7TH ST SUITE B-104
PHOENIX AZ
85022-4382
US

IV. Provider business mailing address

14001 N 7TH ST SUITE B-104
PHOENIX AZ
85022-4382
US

V. Phone/Fax

Practice location:
  • Phone: 602-993-2959
  • Fax: 602-548-5881
Mailing address:
  • Phone: 602-993-2959
  • Fax: 602-548-5881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCSW0567
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: