Provider Demographics
NPI:1881107423
Name:SEMENTA, CYNTHIA JUNE (SSP)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:JUNE
Last Name:SEMENTA
Suffix:
Gender:F
Credentials:SSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 N LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-1825
Mailing Address - Country:US
Mailing Address - Phone:847-949-2714
Mailing Address - Fax:
Practice Address - Street 1:122 S GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-2769
Practice Address - Country:US
Practice Address - Phone:847-949-2714
Practice Address - Fax:847-949-2710
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool