Active NPI
Maximo Moreno III, CO 60653500
- Addiction (Substance Use Disorder) Counselor
- Everett, WA
National Provider Identifier
1639616220
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 1174784185
- Practice address
- 5007 Claremont Way
Everett, WA 98203-3321 - Phone
- (425) 609-5504
- Fax
- (425) 609-5506
- NPI assigned
- Jan 20, 2017
- 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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 1174784185 | WA | Primary |
Addresses
Primary practice location
5007 Claremont Way
Everett, WA 98203-3321
Mailing address
PO Box 34703
Seattle, WA 98124-1703
Phone (206) 764-0502
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1174784185 | WA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1484870400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1484870400000",
"number": "1639616220",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 34703",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981241703",
"telephone_number": "206-764-0502",
"fax_number": "206-764-0516"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5007 CLAREMONT WAY",
"city": "EVERETT",
"state": "WA",
"postal_code": "982033321",
"telephone_number": "425-609-5504",
"fax_number": "425-609-5506"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORENO",
"first_name": "MAXIMO",
"name_suffix": "III",
"credential": "CO 60653500",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-01-20",
"last_updated": "2017-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WA",
"license": "1174784185",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Everett, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.