Maxine Jean Douglas, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW005840 Issued in GA

Practice address

10 Perimeter Summit Blvd NE Unit 4408
Brookhaven, GA 30319-1487

Phone

(404) 468-3284

Fax

(678) 309-1039

NPI assigned

Jan 5, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Maxine Jean Zandieh Former name

Medicare fee-for-service enrollment

Enrolled in GA

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

Specialty

Clinical Social Worker

Education

Other, 1997

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  GA

  Medicare reassignment
• Me Living Inc

  dba Me Living

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Bakersfield, CA
  • NPI 1841037231

  GA

  Medicare reassignment
• Spine Center Atlanta Rehabilitation & Wellness Center, LLC

  • Physical Therapy Clinic/Center
  • Atlanta, GA
  • NPI 1487838900
  NPD

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

{
    "created_epoch": "1609804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609804800000",
    "number": "1871181974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 PERIMETER SUMMIT BLVD NE UNIT 4408",
            "city": "BROOKHAVEN",
            "state": "GA",
            "postal_code": "303191487",
            "telephone_number": "404-468-3284",
            "fax_number": "678-309-1039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 PERIMETER SUMMIT BLVD NE UNIT 4408",
            "city": "BROOKHAVEN",
            "state": "GA",
            "postal_code": "303191487",
            "telephone_number": "404-468-3284",
            "fax_number": "678-309-1039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "MAXINE",
        "middle_name": "JEAN",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-05",
        "last_updated": "2021-01-05",
        "certification_date": "2021-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW005840",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MAXINE",
            "last_name": "ZANDIEH",
            "middle_name": "JEAN",
            "credential": "MSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jody Dinh
• Kawanda Dolson, RBT
• Nadine L Donahue, NP
• Messiah Donaldson, RBT
• Angelica Donato, DC
• Paulette Douse, RBT
• Patricia Louise Drerup-Cotter, LPC
• Johnathan S Dubin, D.M.D.
• Zachary Dubin, DMD
• Carly Davis Ducharme, AUD

• Clinical Social Worker in Brookhaven, GA
• Providers in Brookhaven, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2021; 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.

Verify at the official NPI Registry.