Provider Demographics
NPI:1245485390
Name:GROVER, CYNTHIA ANN (LCSW, LADC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANN
Last Name:GROVER
Suffix:
Gender:F
Credentials:LCSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 KERRI FARMS DR
Mailing Address - Street 2:
Mailing Address - City:STANDISH
Mailing Address - State:ME
Mailing Address - Zip Code:04084-5435
Mailing Address - Country:US
Mailing Address - Phone:207-831-7456
Mailing Address - Fax:207-929-9181
Practice Address - Street 1:86 TANENBERG TRAIL
Practice Address - Street 2:SMART CHILD AND FAMILY SERVICES
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062
Practice Address - Country:US
Practice Address - Phone:207-893-0386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LC2410101YA0400X
MELC74441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)