Provider Demographics
NPI:1528136637
Name:MCKANE, MAUREEN (LCSW)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:MCKANE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:LYONS
Other - Last Name:MCKANE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:120 INGLESIDE AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506
Mailing Address - Country:US
Mailing Address - Phone:630-897-8598
Mailing Address - Fax:
Practice Address - Street 1:1121 E MAIN ST
Practice Address - Street 2:MCKANE & ASSOCIATES #210
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174
Practice Address - Country:US
Practice Address - Phone:630-377-7226
Practice Address - Fax:630-377-8826
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0004582166OtherBLUE CROSS BLUE SHIELD
K13688Medicare ID - Type Unspecified