Provider Demographics
NPI:1568071322
Name:DUQUETTE, MAXWELL ALEXANDER
Entity Type:Individual
Prefix:MR
First Name:MAXWELL
Middle Name:ALEXANDER
Last Name:DUQUETTE
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 1:539 SPRUCE HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:WATERBURY CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05677-8065
Mailing Address - Country:US
Mailing Address - Phone:802-585-5437
Mailing Address - Fax:
Practice Address - Street 1:53 OLD FARM RD
Practice Address - Street 2:
Practice Address - City:STOWE
Practice Address - State:VT
Practice Address - Zip Code:05672-4434
Practice Address - Country:US
Practice Address - Phone:802-373-2909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT097.0134809104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker