Provider Demographics
NPI:1982760344
Name:SHIRTCLIFF, CINDY L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CINDY
Middle Name:L
Last Name:SHIRTCLIFF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CINDY
Other - Middle Name:L
Other - Last Name:SHIRTCLIFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:621 W MADRONE ST
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-3090
Mailing Address - Country:US
Mailing Address - Phone:541-673-0057
Mailing Address - Fax:541-673-2270
Practice Address - Street 1:621 W MADRONE ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-3090
Practice Address - Country:US
Practice Address - Phone:541-440-3532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL28461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR027977Medicaid
OR106462Medicare ID - Type Unspecified
OR027977Medicaid