Provider Demographics
NPI:1073523809
Name:WHITMAN, MAXINE (LCSW)
Entity Type:Individual
Prefix:
First Name:MAXINE
Middle Name:
Last Name:WHITMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6401 ODANA RD STE A
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1126
Mailing Address - Country:US
Mailing Address - Phone:608-204-6076
Mailing Address - Fax:608-204-9568
Practice Address - Street 1:6401 ODANA RD STE A
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1126
Practice Address - Country:US
Practice Address - Phone:608-204-6076
Practice Address - Fax:608-204-9568
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7219-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41003600Medicaid
WI0000215085Medicare PIN