Provider Demographics
NPI:1811029358
Name:REYNOLDS, CYNTHIA L (LCSW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:L
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5660 CAITO DR
Mailing Address - Street 2:SUITE 122
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46226-1372
Mailing Address - Country:US
Mailing Address - Phone:317-771-8913
Mailing Address - Fax:
Practice Address - Street 1:5660 CAITO DR
Practice Address - Street 2:SUITE 122
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-1372
Practice Address - Country:US
Practice Address - Phone:317-771-8913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87001331A101YA0400X
IN34006007A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1632549OtherBLUE CROSS BLUE SHIELD