Provider Demographics
NPI:1437251824
Name:CHICOINE, MARY CYNTHIA (ACSW LISW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:CYNTHIA
Last Name:CHICOINE
Suffix:
Gender:F
Credentials:ACSW LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001 HICKMAN ROAD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322
Mailing Address - Country:US
Mailing Address - Phone:515-473-6240
Mailing Address - Fax:
Practice Address - Street 1:3601 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310
Practice Address - Country:US
Practice Address - Phone:515-277-2126
Practice Address - Fax:515-277-0548
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00585104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker