Provider Demographics
NPI:1053895334
Name:CROSSON, CYNTHIA DIANNE (EDD, LICSW)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:DIANNE
Last Name:CROSSON
Suffix:
Gender:F
Credentials:EDD, LICSW
Other - Prefix:DR
Other - First Name:CYNTHIA
Other - Middle Name:D
Other - Last Name:CROSSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:PO BOX 781
Mailing Address - Street 2:
Mailing Address - City:PETERSHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01366-0781
Mailing Address - Country:US
Mailing Address - Phone:978-724-3472
Mailing Address - Fax:
Practice Address - Street 1:4 EAST ST
Practice Address - Street 2:
Practice Address - City:PETERSHAM
Practice Address - State:MA
Practice Address - Zip Code:01366-9739
Practice Address - Country:US
Practice Address - Phone:978-724-3472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1034331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical