Provider Demographics
NPI:1255393153
Name:HACK, CYNTHIA K (LMSW, CSW)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:K
Last Name:HACK
Suffix:
Gender:F
Credentials:LMSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S WENONA ST
Mailing Address - Street 2:SUITE G29
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-8820
Mailing Address - Country:US
Mailing Address - Phone:989-893-3212
Mailing Address - Fax:989-893-0461
Practice Address - Street 1:200 S WENONA ST
Practice Address - Street 2:SUITE G29
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-8820
Practice Address - Country:US
Practice Address - Phone:989-893-3212
Practice Address - Fax:989-893-0461
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010823281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP16440001Medicare ID - Type UnspecifiedMEDICARE