Basic Information
| Provider Information | |||||||||
| NPI: | 1003942285 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEJSTER | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3903 INDIANAPOLIS BLVD | ||||||||
| Address2: | |||||||||
| City: | EAST CHICAGO | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463122555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2193926065 | ||||||||
| FaxNumber: | 2193926998 | ||||||||
| Practice Location | |||||||||
| Address1: | 3903 INDIANAPOLIS BLVD | ||||||||
| Address2: | |||||||||
| City: | EAST CHICAGO | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463122555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2193926065 | ||||||||
| FaxNumber: | 2193926998 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2007 | ||||||||
| LastUpdateDate: | 04/08/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 34005038A | IN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 200275200A | 05 | IN | MEDICAID |