Provider Demographics
NPI:1164471371
Name:GAYDON, CYNTHIA A (LCSW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:GAYDON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 RUE BEAUREGARD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3129
Mailing Address - Country:US
Mailing Address - Phone:337-233-7551
Mailing Address - Fax:337-233-7552
Practice Address - Street 1:120 RUE BEAUREGARD
Practice Address - Street 2:SUITE 202
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3129
Practice Address - Country:US
Practice Address - Phone:337-233-7551
Practice Address - Fax:337-233-7552
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA39451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
00460353OtherVALUE OPTIONS
LA1560626Medicaid
2240373OtherCIGNA BEHAVIORAL HEALTH
128587OtherCOMPSYCH CORP
157610OtherMANAGED HEALTH NETWORK
00460353OtherVALUE OPTIONS