Provider Demographics
NPI:1538502406
Name:ALLISON, CYNARA CONROY (MFT)
Entity Type:Individual
Prefix:
First Name:CYNARA
Middle Name:CONROY
Last Name:ALLISON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MRS
Other - First Name:CYNARA
Other - Middle Name:
Other - Last Name:MIGLIONINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1466 MANHATTAN BEACH BLVD. #4
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266
Mailing Address - Country:US
Mailing Address - Phone:310-406-8817
Mailing Address - Fax:
Practice Address - Street 1:1716 MANHATTAN BEACH BLVD. #C
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266
Practice Address - Country:US
Practice Address - Phone:310-406-8817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT18153106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist