MEDICARE: CYNTHIA J EMERSON LCPC

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	101YP2500X	Professional Counselor	CC3002	ME

General Provider Information

NPI Number	:	1174650345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA J EMERSON LCPC

Provider Business Mailing Address
First Line	:	160 LAPOINT ROAD
Second Line	:	STETSON RANCH NFI NORTH
City	:	STETSON
State	:	ME
Zip	:	04488
Country	:	US
Telephone Number	:	207-296-2487
Fax Number	:	207-296-2488

Provider Business Practice Location Address
First Line	:	160 LAPOINT RD
Second Line	:	STETSON RANCH NFI NORTH
City	:	STETSON
State	:	ME
Zip	:	04488-3525
Country	:	US
Telephone Number	:	207-296-2487
Fax Number	:	207-296-2488

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

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	08/08/2013

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