Provider Demographics
NPI:1689137341
Name:MAXWELL, ELIMAY LOIS (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIMAY
Middle Name:LOIS
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5245 N UNIVERSITY DR STE A
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33351-5017
Mailing Address - Country:US
Mailing Address - Phone:754-213-1619
Mailing Address - Fax:954-440-0267
Practice Address - Street 1:5245 N UNIVERSITY DR STE A
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33351-5017
Practice Address - Country:US
Practice Address - Phone:954-993-1578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-10
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW150461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL117108600Medicaid