Provider Demographics
NPI:1588813794
Name:ERIKSSON, CYNTHIA BLOMQUIST (PHD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:BLOMQUIST
Last Name:ERIKSSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 N OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1714
Mailing Address - Country:US
Mailing Address - Phone:626-396-6002
Mailing Address - Fax:626-584-9630
Practice Address - Street 1:180 N OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1714
Practice Address - Country:US
Practice Address - Phone:626-396-6002
Practice Address - Fax:626-584-9630
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16508103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY16508OtherCALIFORNIA LICENSE NUMBER