Provider Demographics
NPI:1881756187
Name:WILLIS, CYNTHIA LOUISE (LCSW)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:LOUISE
Last Name:WILLIS
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 1:301 E 79TH STREET
Mailing Address - Street 2:SUITE NUMBER 26M CYNTHIA WILLIS LCSW
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-0946
Mailing Address - Country:US
Mailing Address - Phone:212-249-2968
Mailing Address - Fax:212-249-7445
Practice Address - Street 1:301 EAST 79TH STREET
Practice Address - Street 2:SUITE 26M CYNTHIA WILLIS LCSW
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-0946
Practice Address - Country:US
Practice Address - Phone:212-249-2968
Practice Address - Fax:212-249-7445
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0338971103TP0814X, 103T00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNH4641Medicare ID - Type Unspecified