Provider Demographics
NPI:1770696478
Name:VINCENT, CYNTHIA LIN (PHD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:LIN
Last Name:VINCENT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 721
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95353-0721
Mailing Address - Country:US
Mailing Address - Phone:209-529-7807
Mailing Address - Fax:209-529-7919
Practice Address - Street 1:909 15TH ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-1130
Practice Address - Country:US
Practice Address - Phone:209-529-7807
Practice Address - Fax:209-529-7919
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17076103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist