Provider Demographics
NPI:1326125964
Name:PON, CYNTHIA TERESA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:TERESA
Last Name:PON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 HOWARD ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2638
Mailing Address - Country:US
Mailing Address - Phone:415-255-3699
Mailing Address - Fax:415-252-3015
Practice Address - Street 1:1990 41ST AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-1101
Practice Address - Country:US
Practice Address - Phone:415-753-7400
Practice Address - Fax:415-753-0164
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 210961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ29539ZMedicare PIN