Provider Demographics
NPI:1740371061
Name:MAY, CYNTHIA RUSSO (LPA)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:RUSSO
Last Name:MAY
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 S TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-6768
Mailing Address - Country:US
Mailing Address - Phone:919-738-8733
Mailing Address - Fax:919-734-9050
Practice Address - Street 1:1619 S TAYLOR ST
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-6768
Practice Address - Country:US
Practice Address - Phone:919-738-8733
Practice Address - Fax:919-734-9050
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1432103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC046GVOtherBCBS
NC6107090Medicaid