Provider Demographics
NPI:1225605645
Name:BAENEN, MAXWELL STEVEN (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:MAXWELL
Middle Name:STEVEN
Last Name:BAENEN
Suffix:
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 HUNTLY CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-5212
Mailing Address - Country:US
Mailing Address - Phone:830-431-0274
Mailing Address - Fax:830-431-0274
Practice Address - Street 1:1432 HUNTLY CT
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-5212
Practice Address - Country:US
Practice Address - Phone:830-431-0274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
OH1-20-45137103K00000X
NC385103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst