Provider Demographics
NPI:1467862599
Name:EARLY-MAXSON, NICOLE ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ANN
Last Name:EARLY-MAXSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19801 N 59TH AVE # 11804
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6801
Mailing Address - Country:US
Mailing Address - Phone:623-329-9741
Mailing Address - Fax:
Practice Address - Street 1:19420 N 59TH AVE STE C269
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-2800
Practice Address - Country:US
Practice Address - Phone:602-843-5484
Practice Address - Fax:602-843-5498
Is Sole Proprietor?:No
Enumeration Date:2014-04-28
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-125841041C0700X
AZLCSW 125841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical