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General NPI Number Information
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NPI Number | 1881214377
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Entity Type | Individual
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Provider Name | VINESSA MAXWELL PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 04/24/2020
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Last Update Date | 04/07/2021
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Provider Practice Location Address
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Address Line | 920 CO OP CITY BLVD APT 14D
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City | BRONX
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State | NY
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Zip | 10475-1634
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Country | US
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Telephone | 347-697-3037
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Fax |
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Provider Business Mailing Address
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Address Line | 920 CO OP CITY BLVD APT 14D
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City | BRONX
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State | NY
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Zip | 10475-1634
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Country | US
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Telephone | 347-697-3037
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 726066
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163WP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
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License Number | 726066
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 726066
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | F402910
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License Number State | NY
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