Provider Demographics
NPI:1962521021
Name:LEARD LONGENECKER, CYNTHIA JUNE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:JUNE
Last Name:LEARD LONGENECKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:JUNE
Other - Last Name:LEARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:150 CORPORATE CENTER DR STE 202
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-1759
Mailing Address - Country:US
Mailing Address - Phone:717-988-9430
Mailing Address - Fax:
Practice Address - Street 1:150 CORPORATE CENTER DR STE 202
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-1759
Practice Address - Country:US
Practice Address - Phone:717-988-9430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190921041C0700X
PACW0163271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103026255Medicaid
PA234790Medicare PIN