Provider Demographics
NPI:1649387663
Name:CHOATE, CYNTHIA D (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:D
Last Name:CHOATE
Suffix:
Gender:F
Credentials:LCSW
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 147
Mailing Address - Street 2:
Mailing Address - City:NORTH BRIDGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04057
Mailing Address - Country:US
Mailing Address - Phone:207-647-4378
Mailing Address - Fax:
Practice Address - Street 1:82 MAIN ST
Practice Address - Street 2:SUITE 7
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009
Practice Address - Country:US
Practice Address - Phone:207-647-4378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC 60201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
23811OtherCIGNA
048380OtherANTHEM/BCBS
62338000OtherMAGELLAN
62338000OtherMAGELLAN