Provider Demographics
NPI:1013005081
Name:BADGER, CYNTHIA ROSE (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:ROSE
Last Name:BADGER
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 OAK ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-1652
Mailing Address - Country:US
Mailing Address - Phone:315-439-6048
Mailing Address - Fax:315-473-9300
Practice Address - Street 1:530 OAK ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-1652
Practice Address - Country:US
Practice Address - Phone:315-439-6048
Practice Address - Fax:315-473-9300
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074783101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYLCSW-R #074783OtherLCSW-R