Provider Demographics
NPI:1285220681
Name:MAIER, KEVIN C (LCSW)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:C
Last Name:MAIER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S PARK RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6113
Mailing Address - Country:US
Mailing Address - Phone:773-501-2962
Mailing Address - Fax:
Practice Address - Street 1:30 N MICHIGAN AVE STE 1618
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3657
Practice Address - Country:US
Practice Address - Phone:773-501-2962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-19
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490118061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical