Provider Demographics
NPI:1588313480
Name:POULSEN, CINDY (LCSW)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:POULSEN
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 1:9546 PHILLIPS RD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14080-9648
Mailing Address - Country:US
Mailing Address - Phone:406-360-3045
Mailing Address - Fax:
Practice Address - Street 1:9546 PHILLIPS RD
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:NY
Practice Address - Zip Code:14080-9648
Practice Address - Country:US
Practice Address - Phone:406-360-3045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-20
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCSW-LIC-486621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical