Provider Demographics
NPI:1093854663
Name:BAXTER, CYNTHIA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:
Last Name:BAXTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:BAXTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:5251 EMERSON STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-1725
Mailing Address - Country:US
Mailing Address - Phone:904-270-6600
Mailing Address - Fax:
Practice Address - Street 1:5251 EMERSON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-4932
Practice Address - Country:US
Practice Address - Phone:904-270-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ7368OtherMEDICARE