Provider Demographics
NPI:1780605238
Name:BENTON, CYNTHIA LYNN (MD)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LYNN
Last Name:BENTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 MANCHACA RD, STE 202
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704
Mailing Address - Country:US
Mailing Address - Phone:512-239-8943
Mailing Address - Fax:860-239-8943
Practice Address - Street 1:3625 MANCHACA RD, STE 202
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704
Practice Address - Country:US
Practice Address - Phone:512-239-8943
Practice Address - Fax:860-239-8943
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM31572084P0800X
CAA698492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184165201Medicaid
TX184165201Medicaid
TX8J2343Medicare PIN
TX8J2343Medicare PIN