Provider Demographics
NPI:1356869135
Name:WOOLLEY, CYDNEY (LCSW)
Entity type:Individual
Prefix:
First Name:CYDNEY
Middle Name:
Last Name:WOOLLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CYDNEY
Other - Middle Name:
Other - Last Name:STAPLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:703 3RD ST BLDG ROOM1120
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47907-2081
Mailing Address - Country:US
Mailing Address - Phone:765-496-3004
Mailing Address - Fax:
Practice Address - Street 1:703 3RD ST BLDG ROOM1120
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47907-2081
Practice Address - Country:US
Practice Address - Phone:765-496-3004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-31
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT318129-35011041C0700X
IN34007882A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical