Provider Demographics
NPI:1578088670
Name:ANNEST, CYNTHIA DANIELA (LCSW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:DANIELA
Last Name:ANNEST
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17942 MOUNTAIN SPRINGS AVE
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-5114
Mailing Address - Country:US
Mailing Address - Phone:208-250-5700
Mailing Address - Fax:
Practice Address - Street 1:215 E HAWAII AVE # 140
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-6011
Practice Address - Country:US
Practice Address - Phone:208-514-2502
Practice Address - Fax:208-375-2217
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-36910104100000X
IDLCSW-411331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker