Active NPI
Michael A Maza, LCSW
- Clinical Social Worker
- Saint Petersburg, FL
National Provider Identifier
1700961109
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- SW13986
- Practice address
- 1050 25TH St N
Saint Petersburg, FL 33713-6842 - Phone
- (720) 363-1622
- NPI assigned
- Oct 25, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149011942 | IL | |
| Clinical Social Worker | 1041C0700X | CSW-687 | CO | |
| Clinical Social Worker | 1041C0700X | SW13986 | FL | Primary |
Addresses
Primary practice location
1050 25TH St N
Saint Petersburg, FL 33713-6842
Mailing address
PO Box 10805
Saint Petersburg, FL 33733-0805
Phone (727) 222-1963
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | michael@streetsidepi.com |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 687 | CO | MD | Mental Health Counselor |
| CSW-687 | CO | MD | Clinical Social Worker |
| SW13986 | FL | MD | Clinical Social Worker |
| 149011942 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161734400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1596931200000",
"number": "1700961109",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 10805",
"city": "SAINT PETERSBURG",
"state": "FL",
"postal_code": "337330805",
"telephone_number": "727-222-1963"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1050 25TH ST N",
"city": "SAINT PETERSBURG",
"state": "FL",
"postal_code": "337136842",
"telephone_number": "720-363-1622"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAZA",
"first_name": "MICHAEL",
"middle_name": "A",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-25",
"last_updated": "2020-08-09",
"certification_date": "2020-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149011942",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CO",
"license": "CSW-687",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "FL",
"license": "SW13986",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "michael@streetsidepi.com",
"affiliation": "N",
"endpointDescription": "Streetside PI LLC",
"address_1": "1050 25th St N",
"city": "Saint Petersburg",
"state": "FL",
"country_code": "US",
"postal_code": "337136842",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Saint Petersburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 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.