Provider Demographics
NPI:1528011715
Name:GROTA, CYNTHIA ANNE (MSSW, ACSW)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:ANNE
Last Name:GROTA
Suffix:
Gender:F
Credentials:MSSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 231
Mailing Address - Street 2:
Mailing Address - City:NEILLSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54456-0231
Mailing Address - Country:US
Mailing Address - Phone:715-743-4369
Mailing Address - Fax:
Practice Address - Street 1:517 COURT ST
Practice Address - Street 2:ROOM 503
Practice Address - City:NEILLSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54456-1971
Practice Address - Country:US
Practice Address - Phone:715-743-5208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI829-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical