Provider Demographics
NPI:1093884751
Name:BERLAND, CYNTHIA (MC NCSP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:BERLAND
Suffix:
Gender:F
Credentials:MC NCSP
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:ELIZABETH
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15002 N 32ND ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4441
Mailing Address - Country:US
Mailing Address - Phone:602-867-5223
Mailing Address - Fax:
Practice Address - Street 1:15002 N 32ND ST
Practice Address - Street 2:DISTRICT ADMINISTRATION CENTER
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4441
Practice Address - Country:US
Practice Address - Phone:602-867-5223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ585911Medicaid