Provider Demographics
NPI:1235403270
Name:MAXIE, RAFIAH (LCSW)
Entity type:Individual
Prefix:MS
First Name:RAFIAH
Middle Name:
Last Name:MAXIE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:759 BYRON CT
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1001
Mailing Address - Country:US
Mailing Address - Phone:708-793-3093
Mailing Address - Fax:708-503-9338
Practice Address - Street 1:400 W 76TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-1640
Practice Address - Country:US
Practice Address - Phone:773-793-3093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490150091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical