Provider Demographics
NPI:1154864668
Name:MAXWELL, KIMATRA
Entity Type:Individual
Prefix:
First Name:KIMATRA
Middle Name:
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIMATRA
Other - Middle Name:
Other - Last Name:LOUIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-0001
Mailing Address - Country:US
Mailing Address - Phone:978-516-4600
Mailing Address - Fax:978-516-4601
Practice Address - Street 1:344 MAIN ST STE 9
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420
Practice Address - Country:US
Practice Address - Phone:978-516-4600
Practice Address - Fax:978-516-4601
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-01
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker