Provider Demographics
NPI:1366893158
Name:WORDELL, MAXANNE
Entity type:Individual
Prefix:
First Name:MAXANNE
Middle Name:
Last Name:WORDELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 KIAHS WAY
Mailing Address - Street 2:
Mailing Address - City:E SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02537-1624
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:49 KIAHS WAY
Practice Address - Street 2:
Practice Address - City:E SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02537-1624
Practice Address - Country:US
Practice Address - Phone:774-294-7347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health