Provider Demographics
NPI:1124728696
Name:KRAUSE, CYNTHIA FAYE (MA,LMFT)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:FAYE
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:MA,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2760 REVOLUTION ST UNIT 104
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-3881
Mailing Address - Country:US
Mailing Address - Phone:321-684-2453
Mailing Address - Fax:
Practice Address - Street 1:2760 REVOLUTION ST UNIT 104
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-3881
Practice Address - Country:US
Practice Address - Phone:321-684-2453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT4560106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist