Provider Demographics
NPI:1285934349
Name:VARDARO, CYNTHIA T (LMSW)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:T
Last Name:VARDARO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:T
Other - Last Name:ZIMPRITSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:557 ALWICK AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4201
Mailing Address - Country:US
Mailing Address - Phone:516-359-2095
Mailing Address - Fax:
Practice Address - Street 1:1555 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-6027
Practice Address - Country:US
Practice Address - Phone:631-666-1615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-23
Last Update Date:2010-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070040104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker