Provider Demographics
NPI:1275816605
Name:DELLAVILLA, CYNTHIA S (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:S
Last Name:DELLAVILLA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:478 BAY MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-4001
Mailing Address - Country:US
Mailing Address - Phone:585-671-9664
Mailing Address - Fax:
Practice Address - Street 1:478 BAY MEADOW DR
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-4001
Practice Address - Country:US
Practice Address - Phone:585-671-9664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029051-11041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY029051-1OtherUNIVERSITY OF THE STATE OF NY EDUCATION DEPT.