Provider Demographics
NPI:1992051569
Name:HUDSON, MAXI F (MS)
Entity type:Individual
Prefix:
First Name:MAXI
Middle Name:F
Last Name:HUDSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 870204
Mailing Address - Street 2:
Mailing Address - City:MILTON VILLAGE
Mailing Address - State:MA
Mailing Address - Zip Code:02187-0204
Mailing Address - Country:US
Mailing Address - Phone:617-293-4265
Mailing Address - Fax:
Practice Address - Street 1:1500 BLUE HILL AVE
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-1746
Practice Address - Country:US
Practice Address - Phone:617-293-4265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral