Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 3540 | AZ |
N | 103T00000X | Psychologist | 3540 | AZ |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 3540 | AZ |
N | 103G00000X | Clinical Psychologist | 3540 | AZ |
N | 103TC0700X | Clinical Psychologist | 3540 | AZ |
Y | 103TH0100X | Health Service | 3540 | AZ |
N | 103TR0400X | Rehabilitation Psychologist | 3540 | AZ |
NPI | 1528109139 |
---|---|
Provider Name | Dr. Barbara M Maxwell |
First Address | Phoenix, AZ 85020-1142 |
Second Address | Phoenix, AZ 85020-1142 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2007 |
Last Update Date | 19/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
876732 | (05) | AZ |
P83539 | (02) | AZ |
PTAN Z75937 | (02) | AZ |