Provider Demographics
NPI:1437462785
Name:KSIAZEK, CYNTHIA (LCSWMS)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:KSIAZEK
Suffix:
Gender:F
Credentials:LCSWMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:857 E VIRGINIA
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77705
Mailing Address - Country:US
Mailing Address - Phone:409-880-8466
Mailing Address - Fax:409-880-7703
Practice Address - Street 1:857 E VIRGINIA
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77705
Practice Address - Country:US
Practice Address - Phone:409-880-8466
Practice Address - Fax:409-880-7703
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX280991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical