Healthcare Provider Details

I. General information

NPI: 1740280684
Provider Name (Legal Business Name): CYNTHIA A. SOLIN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 DWIGHT RD
LONGMEADOW MA
01106-1748
US

IV. Provider business mailing address

PO BOX 60181
LONGMEADOW MA
01116-0181
US

V. Phone/Fax

Practice location:
  • Phone: 413-567-2350
  • Fax:
Mailing address:
  • Phone: 413-567-2350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number104678
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: