Provider Demographics
NPI:1861510406
Name:MAXSON, JONATHAN WADE (MSW)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:WADE
Last Name:MAXSON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 HATCH DR
Mailing Address - Street 2:P.O. BOX 1018
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-2161
Mailing Address - Country:US
Mailing Address - Phone:207-493-3361
Mailing Address - Fax:207-492-4889
Practice Address - Street 1:24 SWEDEN ST
Practice Address - Street 2:
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-2127
Practice Address - Country:US
Practice Address - Phone:207-493-3361
Practice Address - Fax:207-492-4889
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC10720104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker