Healthcare Provider Details

I. General information

NPI: 1609030576
Provider Name (Legal Business Name): CYNTHIA FAYE CONSAUL LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 NORTH RD
SCOTTSVILLE NY
14546-1131
US

IV. Provider business mailing address

640 NORTH RD
SCOTTSVILLE NY
14546-1131
US

V. Phone/Fax

Practice location:
  • Phone: 585-503-1281
  • Fax: 855-485-1189
Mailing address:
  • Phone: 585-503-1281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR047233-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: