Provider Demographics
NPI:1033550462
Name:MONDRAGON, ANDRES (MSW)
Entity Type:Individual
Prefix:
First Name:ANDRES
Middle Name:
Last Name:MONDRAGON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 BONNER DR.
Mailing Address - Street 2:JAMESTOWN SITE
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282
Mailing Address - Country:US
Mailing Address - Phone:336-387-6161
Mailing Address - Fax:336-387-9167
Practice Address - Street 1:315 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2911
Practice Address - Country:US
Practice Address - Phone:336-387-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0082361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical