Provider Demographics
NPI:1588927677
Name:PANTOL, CYNTHIA LYN (MASTERS)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:LYN
Last Name:PANTOL
Suffix:
Gender:
Credentials:MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 BERNSTEIN BLVD
Mailing Address - Street 2:
Mailing Address - City:CENTER MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11934-1402
Mailing Address - Country:US
Mailing Address - Phone:631-909-2243
Mailing Address - Fax:
Practice Address - Street 1:214 BERNSTEIN BLVD
Practice Address - Street 2:
Practice Address - City:CENTER MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11934-1402
Practice Address - Country:US
Practice Address - Phone:631-909-2243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2427103K00000X
NY001757103K00000X
NY630650051174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst