Healthcare Provider Details

I. General information

NPI: 1841573680
Provider Name (Legal Business Name): CYNTHIA AUSTIN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2011
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE MLC 3015
CINCINNATI OH
45244
US

IV. Provider business mailing address

1600 W 38TH ST STE 320
AUSTIN TX
78731-6406
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4336
  • Fax:
Mailing address:
  • Phone: 512-324-3560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number38149
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number7066
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: