Provider Demographics
NPI:1194957852
Name:SUAREZ, CYNTHIA ANNE (LCSW)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:ANNE
Last Name:SUAREZ
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 1:2094 E ROYAL DORNOCH AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93730-5142
Mailing Address - Country:US
Mailing Address - Phone:559-285-6077
Mailing Address - Fax:559-645-8802
Practice Address - Street 1:2585 E PERRIN AVE
Practice Address - Street 2:STE. 107
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-5205
Practice Address - Country:US
Practice Address - Phone:559-285-6077
Practice Address - Fax:559-645-8802
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-14
Last Update Date:2009-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS253401041C0700X
VA09040023941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA205284OtherTRIGON/ANTHEM BLUE CROSS BLUE SHIELD
VA297645OtherMAGELLAN
VA8927812Medicaid