Provider Demographics
NPI:1073771200
Name:CHRISTOPHERSON, CYNTHIA (LCSW; BCABA)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:CHRISTOPHERSON
Suffix:
Gender:F
Credentials:LCSW; BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 NW MAGNOLIA LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3580
Mailing Address - Country:US
Mailing Address - Phone:772-708-9711
Mailing Address - Fax:772-785-8716
Practice Address - Street 1:224 NW MAGNOLIA LAKES BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3580
Practice Address - Country:US
Practice Address - Phone:772-708-9711
Practice Address - Fax:772-785-8716
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW-87181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical