Provider Demographics
NPI:1619930112
Name:DEMETRI, CYNTHIA L (LCPC LADC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:DEMETRI
Suffix:
Gender:F
Credentials:LCPC LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 LAMBARD RD
Mailing Address - Street 2:103
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5954
Mailing Address - Country:US
Mailing Address - Phone:207-368-2072
Mailing Address - Fax:
Practice Address - Street 1:442 MOOSEHEAD TRAIL
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:ME
Practice Address - Zip Code:04953-2123
Practice Address - Country:US
Practice Address - Phone:207-368-2072
Practice Address - Fax:207-368-5290
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC882101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME245730099Medicaid