Provider Demographics
NPI:1174974927
Name:EXANTUS, MAX (MS)
Entity type:Individual
Prefix:MR
First Name:MAX
Middle Name:
Last Name:EXANTUS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8201 THAMES BLVD APT D
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-8394
Mailing Address - Country:US
Mailing Address - Phone:561-666-2736
Mailing Address - Fax:
Practice Address - Street 1:8201 THAMES BLVD APT D
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-8394
Practice Address - Country:US
Practice Address - Phone:561-666-2736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health