Provider Demographics
NPI:1225751084
Name:VIERA BRECKENRIDGE, CYNTHIA AMARYLIS (LCSW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:AMARYLIS
Last Name:VIERA BRECKENRIDGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMARYLIS
Other - Middle Name:
Other - Last Name:VIERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:611 S KINGSLEY DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-2319
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:611 S KINGSLEY DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-2319
Practice Address - Country:US
Practice Address - Phone:213-973-7122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical