Provider Demographics
NPI:1215195128
Name:MATHIS, RAMONA HERNANDEZ (LCSW)
Entity type:Individual
Prefix:MS
First Name:RAMONA
Middle Name:HERNANDEZ
Last Name:MATHIS
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 1:53322 CATALINA CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1342
Mailing Address - Country:US
Mailing Address - Phone:574-273-1598
Mailing Address - Fax:574-968-0615
Practice Address - Street 1:53322 CATALINA CT
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1342
Practice Address - Country:US
Practice Address - Phone:574-273-1598
Practice Address - Fax:574-968-0615
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002783A1041C0700X
IN35000537A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2268OtherNATIONAL BOARD OF CERTIFIED CLINICAL HYPNOTHERAPISTS, FELLOW STATUS