Provider Demographics
NPI:1649831074
Name:MAXWELL, REBECCA M
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:M
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:MAXWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:5217 CHEVY CHASE PKWY NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-1747
Mailing Address - Country:US
Mailing Address - Phone:202-966-4335
Mailing Address - Fax:
Practice Address - Street 1:5217 CHEVY CHASE PKWY NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-1747
Practice Address - Country:US
Practice Address - Phone:202-966-4335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD213091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical