Provider Demographics
NPI:1609028588
Name:MONDRAGON, MARIA GABRIELA (LICSW)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:GABRIELA
Last Name:MONDRAGON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 S 2ND ST STE 412
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-2629
Mailing Address - Country:US
Mailing Address - Phone:509-785-6818
Mailing Address - Fax:509-420-9747
Practice Address - Street 1:6 S 2ND ST STE 412
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-2629
Practice Address - Country:US
Practice Address - Phone:509-785-6818
Practice Address - Fax:509-420-9747
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00051889101Y00000X
WASC60147844101YM0800X
WALW603423881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health