Healthcare Provider Details

I. General information

NPI: 1164069670
Provider Name (Legal Business Name): CATHY MAXI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2019
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 WATER ST
FITCHBURG MA
01420-5478
US

IV. Provider business mailing address

130 WATER ST
FITCHBURG MA
01420-5747
US

V. Phone/Fax

Practice location:
  • Phone: 978-878-8300
  • Fax: 978-627-8349
Mailing address:
  • Phone: 978-878-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2290081
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2290081
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: