Provider Demographics
NPI:1942589494
Name:WOOD, CYNTHIA J (LCSW, MS, CASAC)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:J
Last Name:WOOD
Suffix:
Gender:F
Credentials:LCSW, MS, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 E GENESEE ST STE 203
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-2534
Mailing Address - Country:US
Mailing Address - Phone:315-569-0272
Mailing Address - Fax:
Practice Address - Street 1:15 E GENESEE ST STE 203
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-2534
Practice Address - Country:US
Practice Address - Phone:315-569-0272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078826-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical