Provider Demographics
NPI:1659769859
Name:MAXWELL, MARTIN RAY JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:RAY
Last Name:MAXWELL
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 REDWING RD STE 210
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-6327
Mailing Address - Country:US
Mailing Address - Phone:970-460-4755
Mailing Address - Fax:
Practice Address - Street 1:2625 REDWING RD STE 210
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-6327
Practice Address - Country:US
Practice Address - Phone:970-460-4755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-23
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099244901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical