Provider Demographics
NPI:1467553511
Name:MAXWELL, SUSAN APANOF (MSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:APANOF
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WOODLAWN AVE
Mailing Address - Street 2:157 SOUTH LAKE AVENUE
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3225
Mailing Address - Country:US
Mailing Address - Phone:518-438-0461
Mailing Address - Fax:518-459-9780
Practice Address - Street 1:17 WOODLAWN AVE
Practice Address - Street 2:157 SOUTH LAKE AVENUE
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3225
Practice Address - Country:US
Practice Address - Phone:518-438-0461
Practice Address - Fax:518-459-9780
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR0131241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPR013124OtherNYS SOCIAL WORK CERTIFICA
NYPR013124OtherNYS SOCIAL WORK CERTIFICA