Healthcare Provider Details

I. General information

NPI: 1043927601
Provider Name (Legal Business Name): SUSAN CIMINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2022
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WESTWOODS DR
LIBERTY MO
64068-1181
US

IV. Provider business mailing address

100 WESTWOODS DR
LIBERTY MO
64068-1181
US

V. Phone/Fax

Practice location:
  • Phone: 816-781-8550
  • Fax:
Mailing address:
  • Phone: 816-781-8550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: