Provider Demographics
NPI:1639104177
Name:WEINSTEIN, MAXINE (PHD)
Entity Type:Individual
Prefix:
First Name:MAXINE
Middle Name:
Last Name:WEINSTEIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13860 SW 73RD CT
Mailing Address - Street 2:
Mailing Address - City:VILLAGE OF PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33158-1214
Mailing Address - Country:US
Mailing Address - Phone:305-238-3166
Mailing Address - Fax:305-251-0533
Practice Address - Street 1:6601 SW 80TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4661
Practice Address - Country:US
Practice Address - Phone:305-661-5574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2680103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75609Medicare ID - Type UnspecifiedPROVIDER NUMBER