Provider Demographics
NPI:1194224568
Name:CONSEILLANT, CYNTHIA N (LCSW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:N
Last Name:CONSEILLANT
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 1:2700 NW 62ND ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1744
Mailing Address - Country:US
Mailing Address - Phone:754-243-5641
Mailing Address - Fax:754-600-3719
Practice Address - Street 1:2700 NW 62ND ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1744
Practice Address - Country:US
Practice Address - Phone:754-243-5641
Practice Address - Fax:754-600-3719
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW14779101Y00000X, 104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker