Provider Demographics
NPI:1497494611
Name:TODD, CYNTHIA B (PHD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:B
Last Name:TODD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:LUIS
Other - Last Name:BALFOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:17003 SW SAPRI WAY
Mailing Address - Street 2:
Mailing Address - City:PORT ST. LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2884
Mailing Address - Country:US
Mailing Address - Phone:561-743-8854
Mailing Address - Fax:
Practice Address - Street 1:17003 SW SAPRI WAY
Practice Address - Street 2:
Practice Address - City:PORT ST. LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2884
Practice Address - Country:US
Practice Address - Phone:561-743-8854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-04
Last Update Date:2022-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS666103TS0200X
FLMH5267101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty