NPIMap

Individual provider Active NPI

Maxwell Maris, PSYD

  • Clinical Psychologist
  • San Diego, CA
National Provider Identifier
1164903530
Registry record updated May 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
35242 Issued in CA
Practice address
5830 Oberlin Dr Ste 204
San Diego, CA 92121-3754
Phone
(858) 609-1549
NPI assigned
Aug 23, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 12, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Clinical Psychologist 103TC0700X 35242 CA Primary

Addresses

Primary practice location

5830 Oberlin Dr Ste 204
San Diego, CA 92121-3754

Mailing address

5830 Oberlin Dr Ste 204
San Diego, CA 92121-3754
Phone (858) 609-1549

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective Oct 10, 2025 through Oct 10, 2027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
35242CAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Community Research Foundation Inc Clinical PastSince Jul 1, 2020 Accepting new patients
Community Research Foundation Inc PastSince Jul 1, 2020 Accepting new patients
Community Research Foundation Inc Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1534982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747008000000",
    "number": "1164903530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5830 OBERLIN DR STE 204",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921213754",
            "telephone_number": "858-609-1549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5830 OBERLIN DR STE 204",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921213754",
            "telephone_number": "858-609-1549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARIS",
        "first_name": "MAXWELL",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-08-23",
        "last_updated": "2025-05-12",
        "certification_date": "2025-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "35242",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.