Provider Demographics
NPI:1417166448
Name:WRIGHT, CYNTHIA HATHAWAY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:HATHAWAY
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TESS
Other - Middle Name:HATHAWAY
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 954
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-0954
Mailing Address - Country:US
Mailing Address - Phone:207-669-6306
Mailing Address - Fax:
Practice Address - Street 1:102 MAIN ST
Practice Address - Street 2:SUITE D
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1919
Practice Address - Country:US
Practice Address - Phone:207-669-6306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC53731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME262640099Medicaid