Provider Demographics
NPI:1699056127
Name:MACLEOD, CYNTHIA JANE (PSYD, LP)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:JANE
Last Name:MACLEOD
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:DR
Other - First Name:CYNTHIA
Other - Middle Name:JANE
Other - Last Name:BOUGHNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD, LP
Mailing Address - Street 1:25885 FARMBROOK RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1174
Mailing Address - Country:US
Mailing Address - Phone:248-354-3775
Mailing Address - Fax:
Practice Address - Street 1:195 W 9 MILE RD STE 106103B
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220
Practice Address - Country:US
Practice Address - Phone:248-497-3921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015680103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical