Provider Demographics
NPI:1245441138
Name:DEFREITAS, CYNTHIA TERESE (MSCCCSLP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:TERESE
Last Name:DEFREITAS
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 STONEY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878-2733
Mailing Address - Country:US
Mailing Address - Phone:401-624-1543
Mailing Address - Fax:
Practice Address - Street 1:2090 WALLUM LAKE ROAD
Practice Address - Street 2:
Practice Address - City:BURRIVILLE
Practice Address - State:RI
Practice Address - Zip Code:02830
Practice Address - Country:US
Practice Address - Phone:401-567-5479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP00758235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist