Healthcare Provider Details

I. General information

NPI: 1902947831
Provider Name (Legal Business Name): JAMES CHARLES MAURER L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1813 W KIRBY AVE
CHAMPAIGN IL
61821-5410
US

IV. Provider business mailing address

611 W PARK ST BWPC
URBANA IL
61801-2529
US

V. Phone/Fax

Practice location:
  • Phone: 217-383-1850
  • Fax: 217-383-3439
Mailing address:
  • Phone: 217-383-6941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149008442
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: