Provider Demographics
NPI:1295373298
Name:USKOV, MAXIM
Entity Type:Individual
Prefix:
First Name:MAXIM
Middle Name:
Last Name:USKOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 SOUTH UNION STREET
Mailing Address - Street 2:BUILDING 2 SUITE 104
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843
Mailing Address - Country:US
Mailing Address - Phone:978-648-8515
Mailing Address - Fax:978-208-6146
Practice Address - Street 1:439 SOUTH UNION STREET
Practice Address - Street 2:BUILDING 2 SUITE 104
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843
Practice Address - Country:US
Practice Address - Phone:978-648-8515
Practice Address - Fax:978-208-6146
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health