Provider Demographics
NPI:1598898439
Name:BURCH, CYNTHIA KAY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:KAY
Last Name:BURCH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 708
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:MA
Mailing Address - Zip Code:01341-0708
Mailing Address - Country:US
Mailing Address - Phone:413-369-4239
Mailing Address - Fax:
Practice Address - Street 1:24 FOURNIER RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:MA
Practice Address - Zip Code:01341-9766
Practice Address - Country:US
Practice Address - Phone:413-369-4239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7149103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical