Provider Demographics
NPI:1952647075
Name:LONG, CYNTHIA A (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:LONG
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 JANEY WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-4224
Mailing Address - Country:US
Mailing Address - Phone:916-606-2756
Mailing Address - Fax:916-731-5576
Practice Address - Street 1:3195 ZINFANDEL DR
Practice Address - Street 2:BLDG G, SUITE 21
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-6376
Practice Address - Country:US
Practice Address - Phone:916-606-2756
Practice Address - Fax:916-731-5576
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-08-4170103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst