Healthcare Provider Details

I. General information

NPI: 1245521582
Provider Name (Legal Business Name): CYNTHIA PARSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 07/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2351 CARDINAL LN ANNEX B
SAN DIEGO CA
92123-3743
US

IV. Provider business mailing address

2351 CARDINAL LN ANNEX B
SAN DIEGO CA
92123-3743
US

V. Phone/Fax

Practice location:
  • Phone: 858-573-2227
  • Fax:
Mailing address:
  • Phone: 858-573-2227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW63290
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: