Provider Demographics
NPI:1891264313
Name:BROOKS, MAXWELL ANDERSON (PSYD)
Entity type:Individual
Prefix:DR
First Name:MAXWELL
Middle Name:ANDERSON
Last Name:BROOKS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 WILSON BLVD UNIT 330
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-6606
Mailing Address - Country:US
Mailing Address - Phone:617-320-6190
Mailing Address - Fax:
Practice Address - Street 1:7801 NORFOLK AVE STE 102
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-6059
Practice Address - Country:US
Practice Address - Phone:301-684-5424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810-006038103TC0700X
MD06186103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical