Provider Demographics
NPI:1669676474
Name:MAKSIMOW, CAROL WINTRODE (ACA, BC-HIS)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:WINTRODE
Last Name:MAKSIMOW
Suffix:
Gender:F
Credentials:ACA, BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 TUTTLE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-1944
Mailing Address - Country:US
Mailing Address - Phone:203-264-1214
Mailing Address - Fax:203-262-8023
Practice Address - Street 1:4 TUTTLE RD
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-1944
Practice Address - Country:US
Practice Address - Phone:203-264-1214
Practice Address - Fax:203-262-8023
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000303237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT061411413OtherFED TAX ID