MEDICARE: MS. CYNTHIA ANGELA HARBOUR-LOGAN LCSW

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	21123	CA

General Provider Information

NPI Number	:	1477747392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CYNTHIA ANGELA HARBOUR-LOGAN LCSW

Provider Business Mailing Address
First Line	:	8939 S SEPULVEDA BLVD STE 110
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3632
Country	:	US
Telephone Number	:	310-498-7694
Fax Number	:

Provider Business Practice Location Address
First Line	:	42455 10TH ST W STE 103
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93534-7060
Country	:	US
Telephone Number	:	661-483-2225
Fax Number	:

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

Provider Enumeration Date	:	09/04/2007
Last Update Date	:	04/23/2025

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