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General NPI Number Information
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NPI Number | 1689958050
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Entity Type | Organization
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Legal Business Name | STEFANIE MAXWELL, PSY.D., P.C.
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Dates
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Enumeration Date | 10/04/2011
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Last Update Date | 10/04/2011
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Provider Practice Location Address
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Address Line | 4305 N LINCOLN AVE OFFICE J
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City | CHICAGO
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State | IL
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Zip | 60618-1711
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Country | US
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Telephone | 773-316-1488
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Fax | 773-271-4562
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Provider Business Mailing Address
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Address Line | 4305 N LINCOLN AVE OFFICE J
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City | CHICAGO
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State | IL
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Zip | 60618-1711
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Country | US
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Telephone | 773-316-1488
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Fax | 773-271-4562
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEFANIE MAXWELL
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Credential | PSY.D.
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Telephone | 773-316-1488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 071-006622
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071-006622
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License Number State | IL
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