Individual provider Active NPI

Mayasa Hameed Hubbard, LCSW

  • Mental Health Counselor
  • Boulder, CO
National Provider Identifier
1780943183
Registry record updated May 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
LCSW-1504 Issued in CO
Practice address
1333 Iris Ave
Boulder, CO 80304-2226
Phone
(303) 445-8500
NPI assigned
May 7, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X LCSW-1504 CO Primary

Addresses

Primary practice location

1333 Iris Ave
Boulder, CO 80304-2226

Mailing address

1333 Iris Ave
Boulder, CO 80304-2226

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170522002431 CO Practitioner - Clinical Social Worker 2062789027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCSW-1504COMDMental Health Counselor

NPI Registry JSON

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

{
    "created_epoch": "1336348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1336348800000",
    "number": "1780943183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1333 IRIS AVE",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803042226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1333 IRIS AVE",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803042226",
            "telephone_number": "303-445-8500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUBBARD",
        "first_name": "MAYASA",
        "middle_name": "HAMEED",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-07",
        "last_updated": "2012-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CO",
            "license": "LCSW-1504",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

Verify at the official NPI Registry.