Provider Demographics
NPI:1366150492
Name:PRUDHOMME, CYNTHIA (LMSW)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:PRUDHOMME
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 N HARRISON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3188
Mailing Address - Country:US
Mailing Address - Phone:443-602-1269
Mailing Address - Fax:
Practice Address - Street 1:3 N HARRISON ST STE 200
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3188
Practice Address - Country:US
Practice Address - Phone:443-602-1269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28267104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker