Provider Demographics
NPI:1447320700
Name:MAXFIELD, CAROL T (PHD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:T
Last Name:MAXFIELD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 221
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-0221
Mailing Address - Country:US
Mailing Address - Phone:917-655-0533
Mailing Address - Fax:413-528-6170
Practice Address - Street 1:115 E 9TH ST
Practice Address - Street 2:APT 2E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-5414
Practice Address - Country:US
Practice Address - Phone:917-655-0533
Practice Address - Fax:413-528-6170
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY011351103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02785326Medicaid
NY02785326Medicaid