Provider Demographics
NPI:1942423686
Name:WANBERG, CYNTHIA B (MED,NCC,LMHC #8966)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:B
Last Name:WANBERG
Suffix:
Gender:F
Credentials:MED,NCC,LMHC #8966
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:HOWEY IN THE HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34737-3140
Mailing Address - Country:US
Mailing Address - Phone:352-324-2319
Mailing Address - Fax:
Practice Address - Street 1:13 CAMINO REAL
Practice Address - Street 2:
Practice Address - City:HOWEY IN THE HILLS
Practice Address - State:FL
Practice Address - Zip Code:34737-3140
Practice Address - Country:US
Practice Address - Phone:352-638-2873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2013-09-09
Deactivation Date:2008-08-12
Deactivation Code:
Reactivation Date:2009-03-17
Provider Licenses
StateLicense IDTaxonomies
FL8966101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health