Provider Demographics
NPI:1053473249
Name:MAXWELL, CYNTHIA K (LSCSW)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:K
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-3433
Mailing Address - Country:US
Mailing Address - Phone:620-757-1083
Mailing Address - Fax:
Practice Address - Street 1:9 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-4035
Practice Address - Country:US
Practice Address - Phone:620-481-6036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS39751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical