Healthcare Provider Details

I. General information

NPI: 1003873555
Provider Name (Legal Business Name): CYNTHIA RACO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 05/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 COLLEGE PARK PLZ
JOHNSTOWN PA
15904-2833
US

IV. Provider business mailing address

214 COLLEGE PARK PLZ
JOHNSTOWN PA
15904-2833
US

V. Phone/Fax

Practice location:
  • Phone: 814-262-0025
  • Fax: 814-266-8745
Mailing address:
  • Phone: 814-262-0025
  • Fax: 814-266-8745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW122710
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW015962
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: