MEDICARE: DR. CYNTHIA MCCABE PSY.D.

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	103TC0700X	Clinical Psychologist	PSY 18225	CA

General Provider Information

NPI Number	:	1699198689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CYNTHIA MCCABE PSY.D.

Provider Business Mailing Address
First Line	:	CALIFORNIA MENS COLONY MENTAL HEALTH
Second Line	:	HWY 1 NORTH, P.O. BOX 8101
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93409-8101
Country	:	US
Telephone Number	:	805-547-7900
Fax Number	:

Provider Business Practice Location Address
First Line	:	CALIFORNIA MENS COLONY MENTAL HEALTH
Second Line	:	HWY 1 NORTH, BOX 8101
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93409-8101
Country	:	US
Telephone Number	:	805-547-7900
Fax Number	:

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

Provider Enumeration Date	:	01/27/2014
Last Update Date	:	05/12/2014

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