Provider Demographics
NPI:1700116597
Name:TUTRONE RANDOLPH, CYNTHIA SANDS (LCSW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:SANDS
Last Name:TUTRONE RANDOLPH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 MIDLAND DR
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06415-1320
Mailing Address - Country:US
Mailing Address - Phone:860-759-0400
Mailing Address - Fax:
Practice Address - Street 1:79 MIDLAND DR
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06415-1320
Practice Address - Country:US
Practice Address - Phone:860-759-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT44281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical