Provider Demographics
NPI:1669973434
Name:GOLDEN, MAXINE LINDA (MA)
Entity type:Individual
Prefix:
First Name:MAXINE
Middle Name:LINDA
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4331 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-1614
Mailing Address - Country:US
Mailing Address - Phone:717-395-8906
Mailing Address - Fax:
Practice Address - Street 1:326 CROTON RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-6340
Practice Address - Country:US
Practice Address - Phone:321-830-7313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1750647657Medicaid