Provider Demographics
NPI:1427493634
Name:BORDEAU, CYNTHIA MARIE (LBSW)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:MARIE
Last Name:BORDEAU
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:MARIE
Other - Last Name:APLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1217 S. EUCLID
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706
Mailing Address - Country:US
Mailing Address - Phone:989-667-9661
Mailing Address - Fax:989-667-9680
Practice Address - Street 1:1217 S. EUCLID
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706
Practice Address - Country:US
Practice Address - Phone:989-667-9661
Practice Address - Fax:989-667-9680
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802063979104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI27-0069327Medicaid