Provider Demographics
NPI:1942631049
Name:KING-MYERS, CYNTHIA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:
Last Name:KING-MYERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7414 S LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60621-3406
Mailing Address - Country:US
Mailing Address - Phone:773-224-5788
Mailing Address - Fax:
Practice Address - Street 1:7414 S LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-3406
Practice Address - Country:US
Practice Address - Phone:773-224-5788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-29
Last Update Date:2017-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150014402104100000X
IL1490184111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker