Provider Demographics
NPI:1336659366
Name:GRONEMEYER, CYNTHIA GRACE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:GRACE
Last Name:GRONEMEYER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 FRANKLIN ST STE 2B
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-3411
Mailing Address - Country:US
Mailing Address - Phone:219-533-0282
Mailing Address - Fax:
Practice Address - Street 1:619 FRANKLIN ST # 2B
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-3411
Practice Address - Country:US
Practice Address - Phone:219-533-0282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-04
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0218801041C0700X
IN34008774A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical