Provider Demographics
NPI:1174542302
Name:BRUCATO, CYNTHIA GRIFFIN (LCSW)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:GRIFFIN
Last Name:BRUCATO
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 1:7586 LINDBERG DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-2227
Mailing Address - Country:US
Mailing Address - Phone:703-704-6179
Mailing Address - Fax:703-799-1053
Practice Address - Street 1:8850 RICHMOND HWY
Practice Address - Street 2:SUITE 202
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22309-1586
Practice Address - Country:US
Practice Address - Phone:703-704-6179
Practice Address - Fax:703-799-1053
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040015091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical