Provider Demographics
NPI:1740362748
Name:DERN, CINDY R (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:CINDY
Middle Name:R
Last Name:DERN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WHITE TAIL DR.
Mailing Address - Street 2:
Mailing Address - City:BEARSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12409-0314
Mailing Address - Country:US
Mailing Address - Phone:845-679-8184
Mailing Address - Fax:
Practice Address - Street 1:15 PINE GROVE ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:NY
Practice Address - Zip Code:12498-1507
Practice Address - Country:US
Practice Address - Phone:845-679-5511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR036475-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN63601Medicare ID - Type Unspecified