Provider Demographics
NPI:1265865463
Name:MAXSON, RAY DANIEL (MSW)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:DANIEL
Last Name:MAXSON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29547 MORNINGMIST DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-6750
Mailing Address - Country:US
Mailing Address - Phone:813-994-5222
Mailing Address - Fax:
Practice Address - Street 1:29547 MORNINGMIST DR
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-6750
Practice Address - Country:US
Practice Address - Phone:813-994-5222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW 76231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical