Provider Demographics
NPI:1093010670
Name:EBERHART, CYNTHIA MARIE (LPT)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:MARIE
Last Name:EBERHART
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15609 BROADFORDING RD
Mailing Address - Street 2:
Mailing Address - City:CLEAR SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:21722
Mailing Address - Country:US
Mailing Address - Phone:301-797-1706
Mailing Address - Fax:
Practice Address - Street 1:15609 BROADFORDING RD
Practice Address - Street 2:
Practice Address - City:CLEAR SPRING
Practice Address - State:MD
Practice Address - Zip Code:21722
Practice Address - Country:US
Practice Address - Phone:301-797-1706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA225100000X252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency