Provider Demographics
NPI:1588963110
Name:NELSON MAXWELL, LILLY JACQUELINE (LICSW, LPN MAS)
Entity type:Individual
Prefix:
First Name:LILLY
Middle Name:JACQUELINE
Last Name:NELSON MAXWELL
Suffix:
Gender:F
Credentials:LICSW, LPN MAS
Other - Prefix:
Other - First Name:LILLY
Other - Middle Name:JACQUELINE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW, LPN MAS
Mailing Address - Street 1:9889 SW 54TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-8694
Mailing Address - Country:US
Mailing Address - Phone:601-896-5363
Mailing Address - Fax:
Practice Address - Street 1:6114 RICKWOOD DR NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35810-2576
Practice Address - Country:US
Practice Address - Phone:601-896-5363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
FLSW196161041C0700X
AL2490C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical