Provider Demographics
NPI:1346573268
Name:TARANTINO-FERNANDEZ, CYNTHIA SUZANNE (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:SUZANNE
Last Name:TARANTINO-FERNANDEZ
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MRS
Other - First Name:CYNTHIA
Other - Middle Name:SUZANNE
Other - Last Name:MADSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:1296 BRAY WAY
Mailing Address - Street 2:
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89410
Mailing Address - Country:US
Mailing Address - Phone:775-782-7675
Mailing Address - Fax:775-782-7675
Practice Address - Street 1:1296 BRAY WAY
Practice Address - Street 2:
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410
Practice Address - Country:US
Practice Address - Phone:775-782-7675
Practice Address - Fax:775-782-7675
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3001-C104100000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical