Provider Demographics
NPI:1174501118
Name:CORACCIO, CYNTHIA S (LCSW)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:S
Last Name:CORACCIO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 TECHNOLOGY WAY
Mailing Address - Street 2:SUITE 3W7
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-3245
Mailing Address - Country:US
Mailing Address - Phone:603-886-5565
Mailing Address - Fax:603-886-8642
Practice Address - Street 1:65 TECHNOLOGY WAY
Practice Address - Street 2:SUITE 3W7
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3245
Practice Address - Country:US
Practice Address - Phone:603-886-5565
Practice Address - Fax:603-886-8642
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3891041C0700X
MA1074521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30420969Medicaid
1015980OtherBEACON FALLON GROUP NUMBE
1036707OtherCIGNA BEHAVIORAL HEALTH
3144743901OtherPACIFICARE
334686OtherMAGELLAN GROUP NUMBER
20514928OtherUNITED HEALTH CARE GROUP
103287OtherMHN
31447439OtherTRICARE
334686OtherAETNA GROUP NUMBER
NH30420969Medicaid