Provider Demographics
NPI:1487960712
Name:MAXFIELD, TERRY D JR (MA, LCMHC)
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:D
Last Name:MAXFIELD
Suffix:JR
Gender:M
Credentials:MA, LCMHC
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 668
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:VT
Mailing Address - Zip Code:05055-0668
Mailing Address - Country:US
Mailing Address - Phone:802-526-9958
Mailing Address - Fax:
Practice Address - Street 1:289 MAIN ST UNIT B211
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:VT
Practice Address - Zip Code:05055-9354
Practice Address - Country:US
Practice Address - Phone:802-526-9958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0057660101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1018048Medicaid