Provider Demographics
NPI:1962739607
Name:MOORE, CYNTHIA TONI (MSSA, LISW-S)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:TONI
Last Name:MOORE
Suffix:
Gender:F
Credentials:MSSA, LISW-S
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:TONI
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSSA, LISW
Mailing Address - Street 1:1799 AKRON PENINSULA RD
Mailing Address - Street 2:SUITE: 205
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-4847
Mailing Address - Country:US
Mailing Address - Phone:330-922-1333
Mailing Address - Fax:
Practice Address - Street 1:1799 AKRON PENINSULA RD
Practice Address - Street 2:SUITE: 205
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-4847
Practice Address - Country:US
Practice Address - Phone:330-922-1333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-17
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1101404-SUPV1041C0700X
OHS.0900982104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker