Provider Demographics
NPI:1861462160
Name:BAHN, CYNTHIA LEIGH (MSW)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:LEIGH
Last Name:BAHN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 S WARREN ST
Mailing Address - Street 2:SUITE 912
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-1798
Mailing Address - Country:US
Mailing Address - Phone:315-445-5554
Mailing Address - Fax:315-446-1562
Practice Address - Street 1:7000 E GENESEE ST
Practice Address - Street 2:BUILDING C- UPPER
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1131
Practice Address - Country:US
Practice Address - Phone:315-445-5554
Practice Address - Fax:315-446-1562
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO161921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB1598Medicare ID - Type Unspecified