Provider Demographics
NPI:1235286352
Name:VACHON, MARY JANE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JANE
Last Name:VACHON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:JANE
Other - Last Name:MURRAY VACHON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:300 N MICHIGAN ST
Mailing Address - Street 2:BOX 42
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1295
Mailing Address - Country:US
Mailing Address - Phone:574-287-7399
Mailing Address - Fax:
Practice Address - Street 1:300 N MICHIGAN ST
Practice Address - Street 2:BOX 42
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1295
Practice Address - Country:US
Practice Address - Phone:574-287-7399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002602A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health