Provider Demographics
NPI:1972660066
Name:HENNARD, CYNTHIA D (MA)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:D
Last Name:HENNARD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 439
Mailing Address - Street 2:
Mailing Address - City:JOHNSON
Mailing Address - State:VT
Mailing Address - Zip Code:05656-0439
Mailing Address - Country:US
Mailing Address - Phone:802-635-7900
Mailing Address - Fax:802-635-7997
Practice Address - Street 1:36 LOWER MAIN ST. EAST
Practice Address - Street 2:
Practice Address - City:JOHNSON
Practice Address - State:VT
Practice Address - Zip Code:05656
Practice Address - Country:US
Practice Address - Phone:802-635-7900
Practice Address - Fax:802-635-7997
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000396101YA0400X
VT068-0000466101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1007041Medicaid