Provider Demographics
NPI:1659494508
Name:STAUFFER, CYNTHIA CAMPBELL (MS)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:CAMPBELL
Last Name:STAUFFER
Suffix:
Gender:F
Credentials:MS
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 739
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17023-0739
Mailing Address - Country:US
Mailing Address - Phone:717-579-6715
Mailing Address - Fax:717-362-8910
Practice Address - Street 1:20 CLEARFIELD STREET
Practice Address - Street 2:
Practice Address - City:ELIZABETHVILLE
Practice Address - State:PA
Practice Address - Zip Code:17023-1702
Practice Address - Country:US
Practice Address - Phone:717-362-8900
Practice Address - Fax:717-362-8910
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006799L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01683842Medicaid
PA1030715460001Medicaid