MEDICARE: MAXFIELD MICHAEL MARTINEZ LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	LSW.0009926362	CO

General Provider Information

NPI Number	:	1104719632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAXFIELD MICHAEL MARTINEZ LSW

Provider Business Mailing Address
First Line	:	1500 N GRANT ST # 5089
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-1859
Country	:	US
Telephone Number	:	970-825-2778
Fax Number	:

Provider Business Practice Location Address
First Line	:	3711 JOHN F KENNEDY PKWY STE 310
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-2658
Country	:	US
Telephone Number	:	970-825-2778
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2025
Last Update Date	:	06/02/2025

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