Provider Demographics
NPI:1295241800
Name:DISBROW, CYNTHIA KAY (LBSW)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:KAY
Last Name:DISBROW
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11845 15 MILE RD APT 1C
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-5146
Mailing Address - Country:US
Mailing Address - Phone:586-946-0158
Mailing Address - Fax:
Practice Address - Street 1:11845 15 MILE RD APT 1C
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-5146
Practice Address - Country:US
Practice Address - Phone:586-946-0158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802046226104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker