Provider Demographics
NPI:1154605574
Name:RAE, CYNTHIA L (MS ED)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:L
Last Name:RAE
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152A SUNSET RD
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-3126
Mailing Address - Country:US
Mailing Address - Phone:302-985-7069
Mailing Address - Fax:
Practice Address - Street 1:254 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-7390
Practice Address - Country:US
Practice Address - Phone:302-985-7069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
DECD-0000055101YA0400X
NJ37LC00221700101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health