Healthcare Provider Details

I. General information

NPI: 1013329556
Provider Name (Legal Business Name): CYNTHIA MARIE MCCLEARY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CYNTHIA MARIE ROSARIO

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 04/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 CUMMINS DR
MODESTO CA
95358-6400
US

IV. Provider business mailing address

1001 MOUNT VERNON DR
MODESTO CA
95350-3033
US

V. Phone/Fax

Practice location:
  • Phone: 209-622-1420
  • Fax:
Mailing address:
  • Phone: 209-986-4025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number88666
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: