Provider Demographics
NPI:1851354575
Name:CONAN, CYNTHIA M (MSW/LCSW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:M
Last Name:CONAN
Suffix:
Gender:F
Credentials:MSW/LCSW
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 185
Mailing Address - Street 2:205 N. MONROE STREET
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-0185
Mailing Address - Country:US
Mailing Address - Phone:610-891-1273
Mailing Address - Fax:
Practice Address - Street 1:205 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3052
Practice Address - Country:US
Practice Address - Phone:610-891-1273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0134281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2319071000OtherBLUE CROSS
PA7829451OtherAETNA