Provider Demographics
NPI:1811222490
Name:MIGNOGNA, JUDITH C (LCSW)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:C
Last Name:MIGNOGNA
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 1:1 NORTHEAST RD
Mailing Address - Street 2:STE. 2-4
Mailing Address - City:STANDISH
Mailing Address - State:ME
Mailing Address - Zip Code:04084-6472
Mailing Address - Country:US
Mailing Address - Phone:207-210-7638
Mailing Address - Fax:201-939-3132
Practice Address - Street 1:1 NORTHEAST RD
Practice Address - Street 2:STE. 2-4
Practice Address - City:STANDISH
Practice Address - State:ME
Practice Address - Zip Code:04084-6472
Practice Address - Country:US
Practice Address - Phone:207-210-7638
Practice Address - Fax:201-939-3132
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-15
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC112341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical