Provider Demographics
NPI:1811185986
Name:VERGARA, CYNTHIA LYNN (MS, MFT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LYNN
Last Name:VERGARA
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:GILLEN
Other - Last Name:CICERON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, MFTI
Mailing Address - Street 1:34 QUEVA VIS
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-2109
Mailing Address - Country:US
Mailing Address - Phone:415-258-4944
Mailing Address - Fax:415-258-4943
Practice Address - Street 1:361 3RD ST
Practice Address - Street 2:SUITE G
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3541
Practice Address - Country:US
Practice Address - Phone:415-258-4944
Practice Address - Fax:415-258-4943
Is Sole Proprietor?:No
Enumeration Date:2007-10-13
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 48660106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist