Provider Demographics
NPI:1043081995
Name:COUSINEAU, MINDY (LMSW-CC)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:COUSINEAU
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 254
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:ME
Mailing Address - Zip Code:04294-0254
Mailing Address - Country:US
Mailing Address - Phone:207-578-1412
Mailing Address - Fax:
Practice Address - Street 1:57 CAMP RD
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:ME
Practice Address - Zip Code:04294-5521
Practice Address - Country:US
Practice Address - Phone:207-578-1412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-10
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC224651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical