Provider Demographics
NPI:1013123462
Name:FONTANELLA, CYNTHIA A (LISW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:FONTANELLA
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-9600
Mailing Address - Fax:
Practice Address - Street 1:CHILDREN'S HOSPITAL GUIDANCE CENTER
Practice Address - Street 2:5675 VENTURE DRIVE
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017
Practice Address - Country:US
Practice Address - Phone:614-355-8080
Practice Address - Fax:614-355-8018
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 06000141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH08258OtherMACSIS