Provider Demographics
NPI:1093439879
Name:MOULDEN-KEYS, CYNTHIA (MHC, INTERN)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:
Last Name:MOULDEN-KEYS
Suffix:
Gender:F
Credentials:MHC, INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01109-4114
Mailing Address - Country:US
Mailing Address - Phone:413-266-2202
Mailing Address - Fax:413-301-5164
Practice Address - Street 1:605 STATE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01109-4114
Practice Address - Country:US
Practice Address - Phone:413-266-2202
Practice Address - Fax:413-301-5164
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health