Provider Demographics
NPI:1750476412
Name:MEDICH, CYNTHIA (PHD APRN PSYCHIATRIC)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:
Last Name:MEDICH
Suffix:
Gender:F
Credentials:PHD APRN PSYCHIATRIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2825
Mailing Address - Country:US
Mailing Address - Phone:508-580-2211
Mailing Address - Fax:508-427-1772
Practice Address - Street 1:529 PEARL ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2825
Practice Address - Country:US
Practice Address - Phone:508-580-2211
Practice Address - Fax:508-427-1772
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152784364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPN0824OtherBLUE SHIELD
MANS0692Medicare ID - Type Unspecified
MAPN0824OtherBLUE SHIELD