Provider Demographics
NPI:1558378828
Name:SPAULDING, CYNTHIA D (MA)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:D
Last Name:SPAULDING
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:D
Other - Last Name:BECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:143 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26362-7465
Mailing Address - Country:US
Mailing Address - Phone:304-643-5399
Mailing Address - Fax:304-643-5398
Practice Address - Street 1:216 W NORTH ST
Practice Address - Street 2:
Practice Address - City:HARRISVILLE
Practice Address - State:WV
Practice Address - Zip Code:26362-1047
Practice Address - Country:US
Practice Address - Phone:304-643-5399
Practice Address - Fax:304-643-5398
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV700103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0164840000Medicaid
WV001705851Medicare UPIN
WV371673Medicare UPIN
WV115328276Medicare UPIN