Provider Demographics
NPI:1497385801
Name:PRAY, CYNTHIA ELLEN (LCSW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ELLEN
Last Name:PRAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 CREEKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ELIOT
Mailing Address - State:ME
Mailing Address - Zip Code:03903-1055
Mailing Address - Country:US
Mailing Address - Phone:207-451-8573
Mailing Address - Fax:
Practice Address - Street 1:178 HAROLD DOW HIGHWAY SUITE 10
Practice Address - Street 2:ROUTE 236
Practice Address - City:ELIOT
Practice Address - State:ME
Practice Address - Zip Code:03903
Practice Address - Country:US
Practice Address - Phone:207-451-8573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC6923101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health