MEDICARE: CYNTHIA POOLE PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	0142871	NY

General Provider Information

NPI Number	:	1023078573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA POOLE PSYD

Provider Business Mailing Address
First Line	:	3180 WEST ST
Second Line	:
City	:	CANANDAIGUA
State	:	NY
Zip	:	14424-1722
Country	:	US
Telephone Number	:	585-394-1442
Fax Number	:	585-394-1257

Provider Business Practice Location Address
First Line	:	3180 WEST ST
Second Line	:
City	:	CANANDAIGUA
State	:	NY
Zip	:	14424-1722
Country	:	US
Telephone Number	:	585-394-1442
Fax Number	:	585-394-1257

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	07/08/2007

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Directions to “ CYNTHIA POOLE PSYD” Practice Location

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