Healthcare Provider Details

I. General information

NPI: 1427316546
Provider Name (Legal Business Name): ALISON MAXFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2012
Last Update Date: 01/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 ATLANTIC AVE
ATLANTIC CITY NJ
08401-6928
US

IV. Provider business mailing address

PO BOX 1086
PLEASANTVILLE NJ
08232-6086
US

V. Phone/Fax

Practice location:
  • Phone: 866-750-6612
  • Fax: 609-645-7343
Mailing address:
  • Phone: 609-272-8580
  • Fax: 609-645-7343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number44SC05531100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: