Provider Demographics
NPI:1700925237
Name:TREMBLAY, CYNTHIA (COTA L, QMRP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:TREMBLAY
Suffix:
Gender:F
Credentials:COTA L, QMRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5203 OGILVIE AVE
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-6764
Mailing Address - Country:US
Mailing Address - Phone:270-534-0978
Mailing Address - Fax:
Practice Address - Street 1:408 E VINE ST
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:IL
Practice Address - Zip Code:62995-1612
Practice Address - Country:US
Practice Address - Phone:618-658-2611
Practice Address - Fax:618-658-2501
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health