MEDICARE: CYNTHIA STIDD, LCSW, LLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1356942015
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CYNTHIA STIDD, LCSW, LLC

Provider Business Mailing Address
First Line	:	60831 WINDSOR DR
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97702-9502
Country	:	US
Telephone Number	:	541-209-0287
Fax Number	:

Provider Business Practice Location Address
First Line	:	60831 WINDSOR DR
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97702-9502
Country	:	US
Telephone Number	:	541-209-0287
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER/OWNER
Name	:	CYNTHIA STIDD
Credential	:	LCSW
Telephone Number	:	541-209-0287

Provider Enumeration Date	:	11/07/2020
Last Update Date	:	11/07/2020

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