MEDICARE: MS. CYNTHIA LEIGH HAUPT LCSW-R

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	101Y00000X	Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	101YM0800X	Mental Health Counselor
4	101YP2500X	Professional Counselor
5	1041C0700X	Clinical Social Worker	R042147-1	NY
6	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1508180365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CYNTHIA LEIGH HAUPT LCSW-R

Provider Business Mailing Address
First Line	:	PO BOX 421
Second Line	:
City	:	CROSS RIVER
State	:	NY
Zip	:	10518-0421
Country	:	US
Telephone Number	:	914-763-0868
Fax Number	:	914-763-0868

Provider Business Practice Location Address
First Line	:	892 ROUTE 35
Second Line	:
City	:	CROSS RIVER
State	:	NY
Zip	:	10518-1141
Country	:	US
Telephone Number	:	914-763-0868
Fax Number	:	914-763-0868

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

Provider Enumeration Date	:	03/23/2010
Last Update Date	:	03/23/2010

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