Provider Demographics
NPI:1922509868
Name:AQUILINA, CYNTHIA JEAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:JEAN
Last Name:AQUILINA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CYNDIE
Other - Middle Name:J
Other - Last Name:AQUILINA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:226 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5968
Mailing Address - Country:US
Mailing Address - Phone:337-764-8703
Mailing Address - Fax:
Practice Address - Street 1:226 PARK AVE
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5968
Practice Address - Country:US
Practice Address - Phone:337-764-8703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA34431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical