Provider Demographics
NPI:1497917967
Name:BURTON, CYNTHIA RAE (LCSW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:RAE
Last Name:BURTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:R
Other - Last Name:HARRAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4545 N WEST AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93705-0946
Mailing Address - Country:US
Mailing Address - Phone:559-229-3561
Mailing Address - Fax:559-229-3681
Practice Address - Street 1:4545 N WEST AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93705-0946
Practice Address - Country:US
Practice Address - Phone:559-229-3561
Practice Address - Fax:559-229-3681
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA232601041C0700X
CA29889101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical