Provider Demographics
NPI:1629296959
Name:NEAL, CYNTHIA GAYLE (PPS)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:GAYLE
Last Name:NEAL
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 DUNTOV DR
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-5976
Mailing Address - Country:US
Mailing Address - Phone:805-489-5957
Mailing Address - Fax:
Practice Address - Street 1:402 FARNEL RD STE A
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-4960
Practice Address - Country:US
Practice Address - Phone:805-922-0334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool