MEDICARE: MAXIME THERAPY LCSW PLLC

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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1720842701
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAXIME THERAPY LCSW PLLC

Provider Business Mailing Address
First Line	:	6 NARCISSUS ROAD WEST
Second Line	:
City	:	MASTIC BEACH
State	:	NY
Zip	:	11951
Country	:	US
Telephone Number	:	508-922-2004
Fax Number	:	855-841-3966

Provider Business Practice Location Address
First Line	:	808 UNION STREET
Second Line	:	SUITE 3A, OFFICE 6
City	:	BROOKLYN
State	:	NY
Zip	:	11215-1121
Country	:	US
Telephone Number	:	508-922-2004
Fax Number	:	855-841-3966

Authorized Official
Title or Position	:	PSYCHOTHERAPIST/CLINICAL SOCIAL WOR
Name	:	FRANCES MARGUERITE MAXIME
Credential	:	LCSW, LICSW
Telephone Number	:	508-922-2004

Provider Enumeration Date	:	02/09/2024
Last Update Date	:	02/09/2024

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