Provider Demographics
NPI:1265457725
Name:SANCHEZ, CYNTHIA DIAZ (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:DIAZ
Last Name:SANCHEZ
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 1:5121 EHRLICH RD
Mailing Address - Street 2:SUITE 104-B
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-2049
Mailing Address - Country:US
Mailing Address - Phone:813-968-8801
Mailing Address - Fax:813-960-9373
Practice Address - Street 1:5121 EHRLICH RD
Practice Address - Street 2:SUITE 104-B
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-2049
Practice Address - Country:US
Practice Address - Phone:813-968-8801
Practice Address - Fax:813-960-9373
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2011-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 25481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFL 2256OtherUNIPSYCH
FLSANCCYNTOtherLIFESYNCH - CORPHEALTH (HUMANA)
FL11614783OtherCAQH
FL2165768OtherCOMPSYCH
FL282088OtherVALUE OPTIONS PROVIDER ID
FL20919OtherCIGNA BEHAVIORAL HEALTH
FL501699693OtherUNITED BEHAVIORAL HEALTH
FL7244935OtherAETNA
FLZ4609OtherBLUE CROSS BLUE SHIELD