Active NPI
Andrew Charles Maynard, LLMSW
- Clinical Social Worker
- Grand Rapids, MI
National Provider Identifier
1669243747
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 790 Fuller Ave NE
Grand Rapids, MI 49503-1918 - Phone
- (616) 336-3909
- Fax
- (616) 336-8830
- NPI assigned
- Jan 9, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | Primary |
Addresses
Primary practice location
790 Fuller Ave NE
Grand Rapids, MI 49503-1918
Mailing address
790 Fuller Ave NE
Grand Rapids, MI 49503-1918
Phone (616) 336-3909
Other practice location 1
376 E Apple Ave
Muskegon, MI 49442-3466
Phone (231) 724-1111
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | pcerecords.network180.x@direct.mihin.net | Direct |
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1704758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1747267200000",
"number": "1669243747",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "790 FULLER AVE NE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495031918",
"telephone_number": "616-336-3909",
"fax_number": "616-336-8830"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "790 FULLER AVE NE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495031918",
"telephone_number": "616-336-3909",
"fax_number": "616-336-8830"
}
],
"practiceLocations": [
{
"address_1": "376 E Apple Ave",
"address_purpose": "LOCATION",
"city": "Muskegon",
"state": "MI",
"postal_code": "494423466",
"country_code": "US",
"telephone_number": "231-724-1111",
"fax_number": "231-724-4188",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MAYNARD",
"first_name": "ANDREW",
"middle_name": "CHARLES",
"credential": "LLMSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-01-09",
"last_updated": "2025-05-15",
"certification_date": "2025-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "pcerecords.network180.x@direct.mihin.net",
"affiliation": "N",
"endpointDescription": "Direct Address",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "790 Fuller Ave NE",
"city": "Grand Rapids",
"state": "MI",
"country_code": "US",
"postal_code": "495031918",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.