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General NPI Number Information
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NPI Number | 1407652126
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Entity Type | Individual
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Provider Name | MAXINE D MARTIN
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Gender | Female
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Dates
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Enumeration Date | 02/22/2025
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Last Update Date | 02/22/2025
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Provider Practice Location Address
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Address Line | 290 NICHOLAS PKWY NW STE 2
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City | CAPE CORAL
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State | FL
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Zip | 33991-3804
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Country | US
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Telephone | 941-777-5324
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Fax |
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Provider Business Mailing Address
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Address Line | 1030 SE 9TH AVE # 150466
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City | CAPE CORAL
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State | FL
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Zip | 33990-3048
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Country | US
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Telephone | 941-777-5324
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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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