Provider Demographics
NPI:1861665614
Name:NESIBA, CYNTHIA LEA (LCSW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LEA
Last Name:NESIBA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:MCGRATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1077 CHAMBERS ST
Mailing Address - Street 2:STE 2
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-3706
Mailing Address - Country:US
Mailing Address - Phone:541-342-8437
Mailing Address - Fax:458-201-7150
Practice Address - Street 1:1077 CHAMBERS ST
Practice Address - Street 2:STE 2
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3706
Practice Address - Country:US
Practice Address - Phone:402-984-3004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3529101YM0800X
ORL6819101YM0800X, 1041C0700X
NE13211041C0700X
NE8102101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025173100Medicaid