Provider Demographics
NPI:1508014143
Name:STEVENS, CYNTHIA ANNETTE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:ANNETTE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22174 JENNIFER DR
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95949-8145
Mailing Address - Country:US
Mailing Address - Phone:530-320-3690
Mailing Address - Fax:
Practice Address - Street 1:22174 JENNIFER DR
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95949-8145
Practice Address - Country:US
Practice Address - Phone:530-320-3690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8926103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical