Provider Demographics
NPI:1184767394
Name:CUTSHALL, CYNTHIA ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:ANN
Last Name:CUTSHALL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1928 SAINT MARYS RD
Mailing Address - Street 2:
Mailing Address - City:MORAGA
Mailing Address - State:CA
Mailing Address - Zip Code:94556-2715
Mailing Address - Country:US
Mailing Address - Phone:925-631-4364
Mailing Address - Fax:
Practice Address - Street 1:1928 SAINT MARYS RD
Practice Address - Street 2:
Practice Address - City:MORAGA
Practice Address - State:CA
Practice Address - Zip Code:94556-2715
Practice Address - Country:US
Practice Address - Phone:925-631-4364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21217103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA125971Medicare PIN
CAW16659OtherMEDICARE GROUP PTAN