Provider Demographics
NPI:1740488873
Name:COCHRAN, CYNTHIA M (LCSW)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:M
Last Name:COCHRAN
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 1:1107 3RD ST SW STE 9
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-3912
Mailing Address - Country:US
Mailing Address - Phone:863-292-6089
Mailing Address - Fax:
Practice Address - Street 1:1107 3RD ST SW STE 9
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3912
Practice Address - Country:US
Practice Address - Phone:863-292-6089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20220368291041C0700X
TN84091041C0700X
FLSW127681041C0700X
COCSW099299621041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200435720DMedicaid