=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003098450
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CYNTHIA A JOSEPH MSW,LMSW,CAAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2007
-----------------------------------------------------
Last Update Date | 11/28/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 N MICHIGAN AVE SUITE 207
-----------------------------------------------------
City | SAGINAW
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48602-4236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-793-2515
-----------------------------------------------------
Fax | 989-793-2517
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 N MICHIGAN AVE SUITE 207
-----------------------------------------------------
City | SAGINAW
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48602-4236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-793-2515
-----------------------------------------------------
Fax | 989-793-2517
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 6801072251
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------