Healthcare Provider Details

I. General information

NPI: 1962211920
Provider Name (Legal Business Name): MAX ANDREW LEPAK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2025
Last Update Date: 10/04/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 DICKINSON PL
WESTFIELD MA
01085-2565
US

IV. Provider business mailing address

34 DICKINSON PL
WESTFIELD MA
01085-2565
US

V. Phone/Fax

Practice location:
  • Phone: 413-579-7299
  • Fax:
Mailing address:
  • Phone: 413-579-7299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: