Provider Demographics
NPI:1699879080
Name:MAXWELL, BARBARA ANN (LCSW)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 LANDINGS DR
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-3242
Mailing Address - Country:US
Mailing Address - Phone:850-271-5491
Mailing Address - Fax:850-215-8551
Practice Address - Street 1:2003B WILSON AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4532
Practice Address - Country:US
Practice Address - Phone:850-215-8552
Practice Address - Fax:850-215-8551
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW40971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ9109Medicare UPIN
FLE0242Medicare ID - Type UnspecifiedSOCIAL WORK