Provider Demographics
NPI:1003678855
Name:IZZO, CYNTHIA THERESE (MSW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:THERESE
Last Name:IZZO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3833 KINGSLAND CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-4429
Mailing Address - Country:US
Mailing Address - Phone:708-254-1720
Mailing Address - Fax:
Practice Address - Street 1:900 ROYAL HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5457
Practice Address - Country:US
Practice Address - Phone:708-254-1720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker