Healthcare Provider Details

I. General information

NPI: 1285874487
Provider Name (Legal Business Name): CYNTHIA A THURSTON LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2009
Last Update Date: 02/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 FLEETWOOD TER
SILVER SPRING MD
20910-5511
US

IV. Provider business mailing address

156 FLEETWOOD TER
SILVER SPRING MD
20910-5511
US

V. Phone/Fax

Practice location:
  • Phone: 301-585-3503
  • Fax:
Mailing address:
  • Phone: 301-585-3503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14542
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: