Provider Demographics
NPI:1619865870
Name:MAXWELL BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:MAXWELL BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PUCHALSKY
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:908-670-5843
Mailing Address - Street 1:400 N TAMPA ST
Mailing Address - Street 2:STE 1550 PMB 928871
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-4719
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 WARDS RAVINE WAY
Practice Address - Street 2:
Practice Address - City:ST JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-9398
Practice Address - Country:US
Practice Address - Phone:908-670-5843
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty