Active NPI
Susan L Maxwell, PHD
- Clinical Psychologist
- Phoenix, AZ
National Provider Identifier
1679787774
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 0276
- Practice address
- 3930 E Camelback Rd
Suite 205
Phoenix, AZ 85018-2617 - Phone
- (602) 956-5501
- Fax
- (602) 468-2794
- NPI assigned
- May 9, 2007
- Last updated
- Oct 17, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 0276 | AZ | Primary |
Addresses
Primary practice location
3930 E Camelback Rd
Suite 205
Phoenix, AZ 85018-2617
Mailing address
3930 E Camelback Rd
Suite 205
Phoenix, AZ 85018-2617
Phone (602) 956-5501
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AZ0132890 | Other | AZ | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051128000087 | AZ | Practitioner - Clinical Psychologist | 2860412582 | Practice locations: Phoenix, AZ |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1971
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
3930 E Camelback Rd
Suite 205
Phoenix, AZ 85018-2634
Phone (602) 956-5501
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0276 | AZ | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192579200000",
"number": "1679787774",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3930 E CAMELBACK RD",
"address_2": "SUITE 205",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850182617",
"telephone_number": "602-956-5501",
"fax_number": "602-468-2794"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3930 E CAMELBACK RD",
"address_2": "SUITE 205",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850182617",
"telephone_number": "602-956-5501",
"fax_number": "602-468-2794"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAXWELL",
"first_name": "SUSAN",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-09",
"last_updated": "2007-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "AZ",
"license": "0276",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "AZ0132890",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.