Provider Demographics
NPI:1639754278
Name:STEWART-SAMPSON, CINDY KATHLEEN (PHD,LCSW)
Entity Type:Individual
Prefix:DR
First Name:CINDY
Middle Name:KATHLEEN
Last Name:STEWART-SAMPSON
Suffix:
Gender:F
Credentials:PHD,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 HONEY LOCUST CT
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-5861
Mailing Address - Country:US
Mailing Address - Phone:813-928-0623
Mailing Address - Fax:
Practice Address - Street 1:311 HONEY LOCUST CT
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-5861
Practice Address - Country:US
Practice Address - Phone:813-928-0623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW4987101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional