Provider Demographics
NPI:1255616553
Name:MAXSON, VAUGHN DANTE
Entity type:Individual
Prefix:
First Name:VAUGHN
Middle Name:DANTE
Last Name:MAXSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 STRATHMORE RD
Mailing Address - Street 2:APT 6
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-7745
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:57 STRATHMORE RD
Practice Address - Street 2:APT 6
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-7745
Practice Address - Country:US
Practice Address - Phone:508-944-9868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst