Active NPI
Maxx Malloy
- Counselor
- San Francisco, CA
National Provider Identifier
1104285170
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 1001 Potrero Ave, Ward 93
San Francisco, CA 94110 - Phone
- (628) 206-8412
- NPI assigned
- Feb 18, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Counselor | 101Y00000X | Primary |
Addresses
Primary practice location
1001 Potrero Ave, Ward 93
San Francisco, CA 94110
Mailing address
1001 Potrero Avenue, Ward 93
San Francisco, CA 94110
Phone (628) 206-8412
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZZ91892Z | Other | CA | SANTA CRUZ COUNTY MEDICARE GROUP PTAN# |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1455753600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1601856000000",
"number": "1104285170",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1001 POTRERO AVENUE, WARD 93",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "94110",
"telephone_number": "628-206-8412"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 POTRERO AVE, WARD 93",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "94110",
"telephone_number": "628-206-8412"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALLOY",
"first_name": "MAXX",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-02-18",
"last_updated": "2020-10-05",
"certification_date": "2020-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SANTA CRUZ COUNTY MEDICARE GROUP PTAN#",
"identifier": "ZZZ91892Z",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Francisco, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.