Healthcare Provider Details

I. General information

NPI: 1073094728
Provider Name (Legal Business Name): MAXWELL WHITE LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 CENTRE ST STE 209
NEWTON MA
02459-2453
US

IV. Provider business mailing address

1340 CENTRE ST STE 209
NEWTON MA
02459-2453
US

V. Phone/Fax

Practice location:
  • Phone: 781-449-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW1143344
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: