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General NPI Number Information
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NPI Number | 1336853282
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Entity Type | Individual
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Provider Name | MAXWELL RUEL
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Gender | Male
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Dates
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Enumeration Date | 01/05/2023
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Last Update Date | 01/05/2023
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Provider Practice Location Address
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Address Line | 409 LEXINGTON ST
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City | WALTHAM
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State | MA
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Zip | 02452-0933
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Country | US
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Telephone | 781-647-9976
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Fax |
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Provider Business Mailing Address
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Address Line | 15 MERRYMOUNT AVE APT 2
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City | QUINCY
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State | MA
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Zip | 02170-2712
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Country | US
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Telephone | 617-756-8330
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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