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General NPI Number Information
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NPI Number | 1619865870
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Entity Type | Organization
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Legal Business Name | MAXWELL BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 06/26/2025
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 120 WARDS RAVINE WAY
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City | ST JOHNS
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State | FL
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Zip | 32259-9398
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Country | US
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Telephone | 908-670-5843
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Fax |
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Provider Business Mailing Address
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Address Line | 400 N TAMPA ST STE 1550 PMB 928871
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City | TAMPA
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State | FL
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Zip | 33602-4719
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | MR. JASON MICHAEL PUCHALSKY
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Credential | LICSW
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Telephone | 908-670-5843
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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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