Madison Max

Primary specialty

CounselorTaxonomy code 101Y00000X

License

178016225 Issued in IL

Practice address

3808 N Ashland Ave
Chicago, IL 60613-5382

Phone

(312) 217-5887

NPI assigned

Nov 30, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Move Therapy and Wellness 1241 LLC

  • Clinical Social Worker
  • Chicago, IL
  • NPI 1306394416
  NPD (past)

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

{
    "created_epoch": "1638230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711497600000",
    "number": "1144988890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3808 N ASHLAND AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606135382",
            "telephone_number": "312-217-5887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3808 N ASHLAND AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606135382",
            "telephone_number": "312-217-5887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAX",
        "first_name": "MADISON",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-30",
        "last_updated": "2024-03-27",
        "certification_date": "2021-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "IL",
            "license": "178016225",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIVATE INSURANCE",
            "identifier": "474726722",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Chicago",
            "affiliation": "Y",
            "affiliationName": "Move Therapy and Wellness 1241 LLC",
            "address_1": "3808 N Ashland Ave",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606135382",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Charles George Mavros, MD
• Elizabeth Mavros
• Gregory M Mavrovic, PHARMD
• Max Care Pharmacy Inc
• Blake Eddy Max, PHARMD
• Maxcare Pharmacy
• Amethyst Maxey, FNP-C
• Maxicare Home Health Services, Inc.
• Maxicare Visiting Physician, Inc
• Rafiah Maxie, LCSW

• Counselor in Chicago, IL
• Providers in Chicago, IL by specialty
• Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2024; 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.