Provider Demographics
NPI:1720314636
Name:WODA, CYNTHIA (LCSWR)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:WODA
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 FOWLER ST STE 1
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-2534
Mailing Address - Country:US
Mailing Address - Phone:845-858-5973
Mailing Address - Fax:845-858-5973
Practice Address - Street 1:26 FOWLER ST STE 1
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-2534
Practice Address - Country:US
Practice Address - Phone:845-858-5973
Practice Address - Fax:845-858-5973
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-28
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0765251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical