Maia Alexis Illa, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

67011 Issued in CA

Practice address

315 Wall St.
Ste. 5
Chico, CA 95928

Phone

(530) 332-8021

NPI assigned

Jan 30, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1201651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587340800000",
    "number": "1225215361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 WALL ST.",
            "address_2": "STE. 5",
            "city": "CHICO",
            "state": "CA",
            "postal_code": "959287800",
            "telephone_number": "530-332-8021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 WALL ST.",
            "address_2": "STE. 5",
            "city": "CHICO",
            "state": "CA",
            "postal_code": "95928",
            "telephone_number": "530-332-8021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ILLA",
        "first_name": "MAIA",
        "middle_name": "ALEXIS",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-01-30",
        "last_updated": "2020-04-20",
        "certification_date": "2020-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041S0200X",
            "taxonomy_group": "",
            "desc": "Social Worker, School",
            "state": "CA",
            "license": "180079547",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "67011",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Roberto V Illa, M.D.
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• Gary A Incaudo, MD
• Innovative Health Care Services

• Clinical Social Worker in Chico, CA
• Providers in Chico, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 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.

Verify at the official NPI Registry.