Doctor Name: | MRS. CRISTINA LYNN MUGRAGE |
NPI Number: | 1306804281 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSW |
License Number: | 149.011980 |
Business Practice Address: | 4700 N Prospect Rd Suite A1 Peoria Heights, IL - 616166451 |
Business Phone Number: | 3092123606 |
Business Fax Number: | 8884741956 |
Mailing Address: | 220 Orlando Ave, NORMAL |
State: | IL |
Postal Code: | 617611356 |
Phone Number: | 3092123606 |
Fax Number: | 8884741956 |
NPI Enumeration Date: | 05/02/2006 |
NPI Last Update Date: | 12/19/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 149.011980 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |