Provider Demographics
NPI:1629363965
Name:HALL, CYNTHIA LEE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:LEE
Last Name:HALL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:LEE
Other - Last Name:PICONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2055 KELLOGG AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-3111
Mailing Address - Country:US
Mailing Address - Phone:951-898-7010
Mailing Address - Fax:951-898-7401
Practice Address - Street 1:2055 KELLOGG AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3111
Practice Address - Country:US
Practice Address - Phone:951-898-7010
Practice Address - Fax:951-898-7401
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT40140106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist