Healthcare Provider Details

I. General information

NPI: 1528162997
Provider Name (Legal Business Name): CYNTHIA L TERRACIANO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3932 SPRINGFIELD RD
GLEN ALLEN VA
23060-4119
US

IV. Provider business mailing address

3932 SPRINGFIELD RD
GLEN ALLEN VA
23060-4119
US

V. Phone/Fax

Practice location:
  • Phone: 804-747-8300
  • Fax: 804-747-6215
Mailing address:
  • Phone: 804-747-8300
  • Fax: 804-747-6215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904001313
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: