Provider Demographics
NPI:1841383569
Name:MAXWELL, MARY JANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:JANE
Last Name:MAXWELL
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 1:11 E 75TH ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2639
Mailing Address - Country:US
Mailing Address - Phone:212-517-7342
Mailing Address - Fax:718-423-3223
Practice Address - Street 1:11 E 75TH ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2639
Practice Address - Country:US
Practice Address - Phone:212-517-7342
Practice Address - Fax:718-423-3223
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008011-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02033190Medicaid
NY0067723OtherGROUP HEALTH INCORPORATED
NY64986OtherCIGNA PROVIDER NUMBER
NYDR9064OtherOXFORD HEALTH PLAN
NYV50610OtherEMPIRE BCBS PROVIDER NO
NY437643OtherAETNA
NY147145OtherVALUE OPTIONS PROVIDER NO
NY6180606OtherUNITED HEALTHCARE PROV NO