Healthcare Provider Details

I. General information

NPI: 1740740539
Provider Name (Legal Business Name): MAXINE WILLOWS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 MILLET ST STE 203
RICHMOND VT
05477-9623
US

IV. Provider business mailing address

65 MILLET ST STE 203
RICHMOND VT
05477-9623
US

V. Phone/Fax

Practice location:
  • Phone: 802-213-9603
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number042.0017061
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: