Provider Demographics
NPI:1659421006
Name:MAXWELL, PAMELA J (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:J
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:450 S MAPLE DR APT 101
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4758
Mailing Address - Country:US
Mailing Address - Phone:818-841-8215
Mailing Address - Fax:818-841-8238
Practice Address - Street 1:2121 W MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-1706
Practice Address - Country:US
Practice Address - Phone:818-841-8215
Practice Address - Fax:818-841-8238
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY12988103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist