Provider Demographics
NPI:1225118037
Name:BENNETT, CYNTHIA D (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:D
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1347 UNION ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-3020
Mailing Address - Country:US
Mailing Address - Phone:518-810-5172
Mailing Address - Fax:518-377-4634
Practice Address - Street 1:1347 UNION ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-3020
Practice Address - Country:US
Practice Address - Phone:518-810-5172
Practice Address - Fax:518-377-4634
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-017360-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02732350Medicaid