Provider Demographics
NPI:1255353702
Name:DAY, MAXINE R (PHD)
Entity type:Individual
Prefix:DR
First Name:MAXINE
Middle Name:R
Last Name:DAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:15720 VENTURA BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2914
Mailing Address - Country:US
Mailing Address - Phone:818-906-0406
Mailing Address - Fax:818-981-0649
Practice Address - Street 1:15720 VENTURA BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2914
Practice Address - Country:US
Practice Address - Phone:818-906-0406
Practice Address - Fax:818-981-0649
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY 19843103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY198430Medicaid