Provider Demographics
NPI:1417653213
Name:CZARNY, MAXWELL WALTER
Entity Type:Individual
Prefix:
First Name:MAXWELL
Middle Name:WALTER
Last Name:CZARNY
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 1:2850 UNIVERSITY SQUARE DR APT 520-A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-5528
Mailing Address - Country:US
Mailing Address - Phone:813-437-2228
Mailing Address - Fax:
Practice Address - Street 1:2850 UNIVERSITY SQUARE DR APT 520-A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-5528
Practice Address - Country:US
Practice Address - Phone:813-437-2228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician