Provider Demographics
NPI:1326379579
Name:DESANTIS, CYNTHIA SCHMID (MSW, LCSW, LCSW-C)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:SCHMID
Last Name:DESANTIS
Suffix:
Gender:F
Credentials:MSW, LCSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001A E HARMONY RD STE 453
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3354
Mailing Address - Country:US
Mailing Address - Phone:970-541-0172
Mailing Address - Fax:
Practice Address - Street 1:375 E HORSETOOTH RD STE 102
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3155
Practice Address - Country:US
Practice Address - Phone:970-541-0172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-27
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD102361041C0700X
DCLC3034231041C0700X
COCSW.099266681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD401438300Medicaid
MD401438300Medicaid