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NPI Code Detail

MEDICARE: DR. MAXINE FIDAN PROFITT PHD

MEDICARE: DR. MAXINE FIDAN PROFITT PHD
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
1103G00000XClinical NeuropsychologistMA

General Provider Information

NPI Number : 1841159852
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MAXINE FIDAN PROFITT PHD
Provider Business Mailing Address
First Line : 55 LAKE AVE N
Second Line :
City : WORCESTER
State : MA
Zip : 01655-0002
Country : US
Telephone Number : 438-884-7195
Fax Number :
Provider Business Practice Location Address
First Line : 55 LAKE AVE N
Second Line :
City : WORCESTER
State : MA
Zip : 01655-0002
Country : US
Telephone Number : 438-884-7195
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2026
Last Update Date : 01/30/2026

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Directions to “ DR. MAXINE FIDAN PROFITT PHD” Practice Location

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