Healthcare Provider Details

I. General information

NPI: 1497385801
Provider Name (Legal Business Name): CYNTHIA ELLEN PRAY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 HAROLD DOW HIGHWAY SUITE 10 ROUTE 236
ELIOT ME
03903
US

IV. Provider business mailing address

33 CREEKVIEW DR
ELIOT ME
03903-1055
US

V. Phone/Fax

Practice location:
  • Phone: 207-451-8573
  • Fax:
Mailing address:
  • Phone: 207-451-8573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC6923
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: