Provider Demographics
NPI:1962619049
Name:MEYER, CYNTHIA WHITE (LICSW)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:WHITE
Last Name:MEYER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1283 ONONDAGA WAY NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-3533
Mailing Address - Country:US
Mailing Address - Phone:651-307-4899
Mailing Address - Fax:651-633-9233
Practice Address - Street 1:2677 INNSBRUCK DR
Practice Address - Street 2:SUITE D
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-6395
Practice Address - Country:US
Practice Address - Phone:651-633-9233
Practice Address - Fax:651-633-9485
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN105101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6383256OtherSTATE ID
MN40F73MEOtherBLUE CROSS BLUE SHIELD