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General NPI Number Information
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NPI Number | 1053646018
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Entity Type | Organization
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Legal Business Name | DAVID M MAX PHD PA
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Dates
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Enumeration Date | 10/08/2009
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Last Update Date | 10/08/2009
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Provider Practice Location Address
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Address Line | 350 NW 70TH AVE
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City | PLANTATION
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State | FL
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Zip | 33317-2349
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Country | US
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Telephone | 954-472-5933
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Fax | 954-587-7527
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Provider Business Mailing Address
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Address Line | PO BOX 15231
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City | PLANTATION
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State | FL
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Zip | 33318-5231
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Country | US
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Telephone | 954-472-5933
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Fax | 954-587-7527
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID MARTIN MAX
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Credential | PHD
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Telephone | 954-472-5933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY3285
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License Number State | FL
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