Provider Demographics
NPI:1689978488
Name:STANLEY, CYNTHIA LEE (CYNTHIA STANLEY MFT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LEE
Last Name:STANLEY
Suffix:
Gender:F
Credentials:CYNTHIA STANLEY MFT
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:LEE
Other - Last Name:STANLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CYNTHIA STANLEY MFT
Mailing Address - Street 1:100 TAMAL PLZ STE 108
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1165
Mailing Address - Country:US
Mailing Address - Phone:415-924-1679
Mailing Address - Fax:415-925-8644
Practice Address - Street 1:100 TAMAL PLZ
Practice Address - Street 2:#108
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1125
Practice Address - Country:US
Practice Address - Phone:415-924-1670
Practice Address - Fax:415-925-8644
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT29830106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist