Provider Demographics
NPI:1073701942
Name:MAXWELL, CAMILLE DIANE (MS)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:DIANE
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-5603
Mailing Address - Country:US
Mailing Address - Phone:518-450-0297
Mailing Address - Fax:518-450-0297
Practice Address - Street 1:627 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-5603
Practice Address - Country:US
Practice Address - Phone:518-450-0297
Practice Address - Fax:518-450-0297
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002512-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist