Provider Demographics
NPI:1861193005
Name:TLOCZKOWSKI, CYNTHIA MARIE (LMHC)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:MARIE
Last Name:TLOCZKOWSKI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ROLLSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11796-1305
Mailing Address - Country:US
Mailing Address - Phone:631-816-4154
Mailing Address - Fax:
Practice Address - Street 1:100 ROLLSTONE AVE
Practice Address - Street 2:
Practice Address - City:WEST SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11796-1305
Practice Address - Country:US
Practice Address - Phone:631-816-4154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001233101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health