Provider Demographics
NPI:1053769505
Name:MATHIESON, CINDY JEAN (LCPC-C)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:JEAN
Last Name:MATHIESON
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:MATHIESON
Other - Last Name:IBECHEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-7144
Mailing Address - Country:US
Mailing Address - Phone:207-945-4240
Mailing Address - Fax:207-990-3660
Practice Address - Street 1:40 SUMMER ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-7144
Practice Address - Country:US
Practice Address - Phone:207-945-4240
Practice Address - Fax:207-990-3660
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4275101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional