Provider Demographics
NPI:1457685943
Name:DOUCETTE, CYNTHIA DENISE (AM, LCSW)
Entity Type:Individual
Prefix:MISS
First Name:CYNTHIA
Middle Name:DENISE
Last Name:DOUCETTE
Suffix:
Gender:F
Credentials:AM, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1187 WILMETTE AVE
Mailing Address - Street 2:PMB 152
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2719
Mailing Address - Country:US
Mailing Address - Phone:847-256-5282
Mailing Address - Fax:
Practice Address - Street 1:64 OLD ORCHARD SHOPPING CTR
Practice Address - Street 2:SUITE 435
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1425
Practice Address - Country:US
Practice Address - Phone:847-256-5282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490137361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical