Healthcare Provider Details

I. General information

NPI: 1053473249
Provider Name (Legal Business Name): CYNTHIA K MAXWELL LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 06/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 W 5TH AVE
EMPORIA KS
66801-4035
US

IV. Provider business mailing address

814 SUNRISE DR
EMPORIA KS
66801-3433
US

V. Phone/Fax

Practice location:
  • Phone: 620-481-6036
  • Fax:
Mailing address:
  • Phone: 620-757-1083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3975
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: