Provider Demographics
NPI:1285903757
Name:CUMMONS, CYNTHIA ELLEN (MSW, LISW-S)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:ELLEN
Last Name:CUMMONS
Suffix:
Gender:F
Credentials:MSW, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 769
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43058-0769
Mailing Address - Country:US
Mailing Address - Phone:740-644-8704
Mailing Address - Fax:740-522-0032
Practice Address - Street 1:2112 CHERRY VALLEY RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1387
Practice Address - Country:US
Practice Address - Phone:740-644-8704
Practice Address - Fax:740-522-0032
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0046921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical