Provider Demographics
NPI:1366558389
Name:GEDDES, CYNTHIA (LCSW)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:GEDDES
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 1:100 EXECUTIVE WAY
Mailing Address - Street 2:SUITE 113
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-2715
Mailing Address - Country:US
Mailing Address - Phone:904-273-6747
Mailing Address - Fax:904-273-6861
Practice Address - Street 1:100 EXECUTIVE WAY
Practice Address - Street 2:SUITE 113
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-2715
Practice Address - Country:US
Practice Address - Phone:904-273-6747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL62571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical