Provider Demographics
NPI:1578789798
Name:WILD, CYNTHIA HELEN (LMHC)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:HELEN
Last Name:WILD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LENOX
Mailing Address - State:MA
Mailing Address - Zip Code:01240-2505
Mailing Address - Country:US
Mailing Address - Phone:413-637-9004
Mailing Address - Fax:
Practice Address - Street 1:89 CHURCH ST
Practice Address - Street 2:
Practice Address - City:LENOX
Practice Address - State:MA
Practice Address - Zip Code:01240-2505
Practice Address - Country:US
Practice Address - Phone:413-637-9004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA977101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health