Provider Demographics
NPI:1033737812
Name:LOGINOV, MAX D (LCSW)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:D
Last Name:LOGINOV
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-5201
Mailing Address - Country:US
Mailing Address - Phone:858-356-7485
Mailing Address - Fax:
Practice Address - Street 1:830 G ST STE 200
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-6256
Practice Address - Country:US
Practice Address - Phone:858-356-7485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA953101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical