Provider Demographics
NPI:1780023556
Name:KANTOS, CYNTHIA MARGARET (LICSW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:MARGARET
Last Name:KANTOS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:MARGARET
Other - Last Name:MOSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1233 34TH ST NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-5112
Practice Address - Country:US
Practice Address - Phone:218-333-5000
Practice Address - Fax:218-333-5360
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN26648104100000X, 1041C0700X
ND4845104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker