NPIMap

Organization Active NPI

Michael Maksimovich LCSW LLC

  • Clinical Social Worker
  • Indianapolis, IN
National Provider Identifier
1033890157
Registry record updated Jul 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
MICHAEL MAKSIMOVICH LCSW LLC
Practice address
6314 Rucker Rd Ste a
Indianapolis, IN 46220-4800
Phone
(317) 250-4149
Fax
(317) 465-9689
NPI assigned
Jul 31, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Michael John Maksimovich, LCSWNPI 1649404377
Title
Owner/President
Phone
(317) 250-4149

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary
Adult Mental Health Clinic/Center 261QM0850X

Addresses

Primary practice location

6314 Rucker Rd Ste a
Indianapolis, IN 46220-4800

Mailing address

6314 Rucker Rd Ste a
Indianapolis, IN 46220-4800
Phone (317) 250-4149

Other identifiers 1

IdentifierTypeStateIssuer
1649404377OtherINNPI

Other names 1

  • Michael Maksimovich Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1690761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690761600000",
    "number": "1033890157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6314 RUCKER RD STE A",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462204800",
            "telephone_number": "317-250-4149",
            "fax_number": "317-465-9689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6314 RUCKER RD STE A",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462204800",
            "telephone_number": "317-250-4149",
            "fax_number": "317-465-9689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL MAKSIMOVICH LCSW LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-31",
        "last_updated": "2023-07-31",
        "certification_date": "2023-07-31",
        "status": "A",
        "authorized_official_last_name": "MAKSIMOVICH",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "317-250-4149",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1649404377",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Michael Maksimovich",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Indianapolis, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.