Provider Demographics
NPI:1386786879
Name:MAXWELL, LAURA SUZANNE (BA)
Entity type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:SUZANNE
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 OLD OKEECHOBEE RD
Mailing Address - Street 2:SUITE 509
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-5253
Mailing Address - Country:US
Mailing Address - Phone:561-683-4778
Mailing Address - Fax:561-683-9995
Practice Address - Street 1:1860 OLD OKEECHOBEE RD
Practice Address - Street 2:SUITE 509
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-5253
Practice Address - Country:US
Practice Address - Phone:561-683-4778
Practice Address - Fax:561-683-9995
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker