Provider Demographics
NPI:1346351780
Name:CYR, JODY L (LCSW, LADC,CCS)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:L
Last Name:CYR
Suffix:
Gender:F
Credentials:LCSW, LADC,CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 W AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-8506
Mailing Address - Country:US
Mailing Address - Phone:207-513-8946
Mailing Address - Fax:
Practice Address - Street 1:435 W AUBURN RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-8506
Practice Address - Country:US
Practice Address - Phone:207-513-8946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC4104101YA0400X
MELC115241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432243199Medicaid