Provider Demographics
NPI:1194541052
Name:BLACK, CINDY ANN (LCSW)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:ANN
Last Name:BLACK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 HUNTS CORNER RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04088-3314
Mailing Address - Country:US
Mailing Address - Phone:781-405-1977
Mailing Address - Fax:
Practice Address - Street 1:25 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-1167
Practice Address - Country:US
Practice Address - Phone:207-524-3501
Practice Address - Fax:207-647-4000
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical