Provider Demographics
NPI:1669873683
Name:LIVSHETZ, MAXIM (PSYD)
Entity type:Individual
Prefix:DR
First Name:MAXIM
Middle Name:
Last Name:LIVSHETZ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MAX
Other - Middle Name:
Other - Last Name:LIVSHETZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:5108 196TH ST SW STE 325
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6152
Mailing Address - Country:US
Mailing Address - Phone:425-894-6337
Mailing Address - Fax:
Practice Address - Street 1:5108 196TH ST SW STE 325
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6152
Practice Address - Country:US
Practice Address - Phone:425-894-6337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60437658103TC0700X, 103TF0200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic