Provider Demographics
NPI:1851895619
Name:MAXWELL, RENEE CECELE
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:CECELE
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-2219
Mailing Address - Country:US
Mailing Address - Phone:508-222-7422
Mailing Address - Fax:508-222-4288
Practice Address - Street 1:63 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2219
Practice Address - Country:US
Practice Address - Phone:508-222-7422
Practice Address - Fax:508-222-4288
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator