Provider Demographics
NPI:1659437994
Name:STROUD, CYNTHIA DIANE (LCSW)
Entity Type:Individual
Prefix:PROF
First Name:CYNTHIA
Middle Name:DIANE
Last Name:STROUD
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 1115
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20134-1115
Mailing Address - Country:US
Mailing Address - Phone:703-819-8231
Mailing Address - Fax:888-809-3270
Practice Address - Street 1:11363 SUNSET HILLS RD
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5205
Practice Address - Country:US
Practice Address - Phone:703-819-8231
Practice Address - Fax:888-809-3270
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA3521718921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA800002975Medicare PIN