Provider Demographics
NPI:1699823724
Name:BROWN, CYNTHIA C (LICSW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:C
Last Name:BROWN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 GREAT RD
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-4157
Mailing Address - Country:US
Mailing Address - Phone:978-266-1940
Mailing Address - Fax:978-692-4784
Practice Address - Street 1:481 GREAT RD
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-4157
Practice Address - Country:US
Practice Address - Phone:978-266-1940
Practice Address - Fax:978-692-4784
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1062781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP04067OtherBLUE CROSS ID
MAP04067OtherBLUE CROSS ID