Provider Demographics
NPI:1689291403
Name:KISSELL, CYNTHIA (LMHC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:KISSELL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:CAMELIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-1425
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:247 WASHINGTON ST STE 26
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-1779
Practice Address - Country:US
Practice Address - Phone:508-930-0154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-27
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7711101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health