Provider Demographics
NPI:1962556555
Name:SELTZER, MAXINE WOLFSON (LCSW)
Entity type:Individual
Prefix:MS
First Name:MAXINE
Middle Name:WOLFSON
Last Name:SELTZER
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 1:14195 MANGO DR
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-2924
Mailing Address - Country:US
Mailing Address - Phone:858-259-0142
Mailing Address - Fax:
Practice Address - Street 1:14195 MANGO DR
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-2924
Practice Address - Country:US
Practice Address - Phone:858-259-0142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS120781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical