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1154268480 NPI number — KELLY A MAYNOR MSW, LCSW

NPI Number: 1154268480
Health Care Provider/Practitioner: KELLY A MAYNOR MSW, LCSW

Information about “1154268480” NPI (KELLY A MAYNOR MSW, LCSW) exists in 1154268480 in HTML format HTML  |  1154268480 in plain Text format TXT  |  1154268480 in PDF (Portable Document Format) PDF  |  1154268480 in an XML format XML  formats.

NPI Number : 1154268480 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1154268480",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MAYNOR",
    "FirstName": "KELLY",
    "MiddleName": "A",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MSW, LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 759",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ANSTED",
    "MailingAddressStateName": "WV",
    "MailingAddressPostalCode": "25812-0759",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "304-640-7788",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "232 HENRY LOVING STREET",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ANSTED",
    "PracticeLocationAddressStateName": "WV",
    "PracticeLocationAddressPostalCode": "25812",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "304-640-7788",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/04/2026",
    "LastUpdateDate": "05/04/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1041C0700X",
        "TaxonomyName": "Clinical Social Worker",
        "LicenseNumber": "CP00946051",
        "LicenseNumberStateCode": "WV",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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