Provider Demographics
NPI:1700139706
Name:ANDERSON, MAXINE K (MD)
Entity Type:Individual
Prefix:DR
First Name:MAXINE
Middle Name:K
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 WESTERN AVENUE
Mailing Address - Street 2:#512
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121
Mailing Address - Country:US
Mailing Address - Phone:206-498-9696
Mailing Address - Fax:
Practice Address - Street 1:2100 WESTERN AVE
Practice Address - Street 2:#69
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121
Practice Address - Country:US
Practice Address - Phone:206-956-4446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00012206102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst