Healthcare Provider Details

I. General information

NPI: 1952585010
Provider Name (Legal Business Name): CYNTHIA SUE BARTON M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 12/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROUTE 40 EXIT 114 BUILDING 1125
LAGUNA NM
87026-0191
US

IV. Provider business mailing address

PO BOX 191
LAGUNA NM
87026-0191
US

V. Phone/Fax

Practice location:
  • Phone: 505-552-9200
  • Fax:
Mailing address:
  • Phone: 505-552-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number307385
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: