Provider Demographics
NPI:1841368099
Name:MAYNOR, JAN MARIE (LISW)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:MARIE
Last Name:MAYNOR
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 HIGH ST
Mailing Address - Street 2:STE A
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-1690
Mailing Address - Country:US
Mailing Address - Phone:330-794-4254
Mailing Address - Fax:330-794-4262
Practice Address - Street 1:680 HIGH ST
Practice Address - Street 2:STE A
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-1690
Practice Address - Country:US
Practice Address - Phone:330-690-2337
Practice Address - Fax:330-822-6955
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00091311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical