Provider Demographics
NPI:1750309647
Name:FUGERE, CYNTHIA E (LMFT, LMHC, MED)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:E
Last Name:FUGERE
Suffix:
Gender:F
Credentials:LMFT, LMHC, MED
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 88
Mailing Address - Street 2:
Mailing Address - City:WALES
Mailing Address - State:MA
Mailing Address - Zip Code:01081-0088
Mailing Address - Country:US
Mailing Address - Phone:413-896-2244
Mailing Address - Fax:413-303-0368
Practice Address - Street 1:1111 ELM ST
Practice Address - Street 2:SUITE 30
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-1540
Practice Address - Country:US
Practice Address - Phone:413-896-2244
Practice Address - Fax:413-303-0368
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA998101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1892657Medicaid