Active NPI
Matthew Maibaum, PHD
- Psychologist
- Los Angeles, CA
National Provider Identifier
1609979277
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY7352
- Practice address
- 1711 W Temple St
Suite 4100
Los Angeles, CA 90026-5421 - Phone
- (213) 739-0019
- Fax
- (213) 739-0091
- NPI assigned
- Sep 7, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY7352 | CA | Primary |
Addresses
Primary practice location
1711 W Temple St
Suite 4100
Los Angeles, CA 90026-5421
Mailing address
3435 Wilshire Blvd Ste 2700-80
Suite 930
Los Angeles, CA 90010-1901
Phone (213) 739-0019
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY7352 | CA | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stuart L Zubrick Marriage Family and Child Counseling a Prof Corp | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinical Psychologist
- Los Angeles, CA
- NPI 1326222019
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157587200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1464912000000",
"number": "1609979277",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3435 WILSHIRE BLVD STE 2700-80",
"address_2": "SUITE 930",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900101901",
"telephone_number": "213-739-0019",
"fax_number": "213-739-0091"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1711 W TEMPLE ST",
"address_2": "SUITE 4100",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900265421",
"telephone_number": "213-739-0019",
"fax_number": "213-739-0091"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAIBAUM",
"first_name": "MATTHEW",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-07",
"last_updated": "2016-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY7352",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.