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General NPI Number Information
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NPI Number | 1952431926
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Entity Type | Individual
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Provider Name | CINDY MONGRAIN MA
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Gender | Female
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 09/30/2022
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Provider Practice Location Address
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Address Line | 53846 GENERATIONS DR
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City | SOUTH BEND
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State | IN
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Zip | 46635-1543
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Country | US
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Telephone | 574-520-8016
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Fax |
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Provider Business Mailing Address
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Address Line | 809 RIVERSIDE CT APT 1C
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City | SOUTH BEND
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State | IN
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Zip | 46616-1602
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Country | US
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Telephone | 574-520-8016
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34009580A
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License Number State | IN
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