Kristine Maynard, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149008276 Issued in IL

Practice address

1030 S. la Grange Rd
Ste #9
La Grange, IL 60525

Phone

(708) 921-3639

Fax

(708) 588-1501

NPI assigned

Feb 8, 2007

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 16, 2022 through Jan 16, 2028

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Kris Maynard LCSW LTD

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • La Grange, IL
  • NPI 1174163463
  NPD Authorized official
• The McGrath Clinic

  • Psychiatric Hospital Unit
  • Orland Park, IL
  • NPI 1265585400
  NPD (past)
• The McGrath Clinic S C

  • Mental Health Counselor
  • Orland Park, IL
  • NPI 1952452971
  NPD (past)
• Deuteronomy

  • General Practice Physician
  • Kaufman, TX
  • NPI 1386665495
  NPD (past)

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580688000000",
    "number": "1215077011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1030 S. LA GRANGE RD",
            "address_2": "STE #9",
            "city": "LA GRANGE",
            "state": "IL",
            "postal_code": "60525",
            "telephone_number": "708-921-3639",
            "fax_number": "708-588-1501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 S. LA GRANGE RD",
            "address_2": "STE #9",
            "city": "LA GRANGE",
            "state": "IL",
            "postal_code": "60525",
            "telephone_number": "708-921-3639",
            "fax_number": "708-588-1501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYNARD",
        "first_name": "KRISTINE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-08",
        "last_updated": "2020-02-03",
        "certification_date": "2020-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149008276",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Marie Marth, MA, CCC-SLP
• Trevissa Martis
• Lisa Massanisso
• Salvatore J Massanisso, RPH
• Dana Evelyn Matasek, OTR/L
• Monica Ann McAndrews, N.P.
• Patricia Ann McCann, APN
• Susan McClenahan, ATC
• Michael B McCrohan, M.D.
• Regina McDougal, LCSW

• Clinical Social Worker in La Grange, IL
• Providers in La Grange, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.