Provider Demographics
NPI:1235508573
Name:WEST, CYNTHIA WOODIS (MA, BCBA)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:WOODIS
Last Name:WEST
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-0026
Mailing Address - Country:US
Mailing Address - Phone:860-642-7379
Mailing Address - Fax:
Practice Address - Street 1:17 OAK ST
Practice Address - Street 2:
Practice Address - City:STONINGTON
Practice Address - State:CT
Practice Address - Zip Code:06378-2766
Practice Address - Country:US
Practice Address - Phone:860-642-7379
Practice Address - Fax:860-201-1200
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1-13-12873103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst