Provider Demographics
NPI:1861505752
Name:HAZEN, CYNTHIA D (PH D LCSW SOCIAL WOR)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:D
Last Name:HAZEN
Suffix:
Gender:F
Credentials:PH D LCSW SOCIAL WOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 BROWNING PL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6508
Mailing Address - Country:US
Mailing Address - Phone:919-787-7125
Mailing Address - Fax:919-781-9952
Practice Address - Street 1:3900 BROWNING PL
Practice Address - Street 2:SUITE 201
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6508
Practice Address - Country:US
Practice Address - Phone:919-787-7125
Practice Address - Fax:919-781-9952
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2008-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0000441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2860330Medicare PIN