Basic Information
| Provider Information | |||||||||
| NPI: | 1639623598 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VEATCH | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | JANE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LICSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BEAN | ||||||||
| OtherFirstName: | CYNTHIA | ||||||||
| OtherMiddleName: | JANE | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7 MEGHANS WAY | ||||||||
| Address2: | |||||||||
| City: | DANVERS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019231880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9787664776 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 57 HIGHLAND AVE | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | SALEM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019702141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9787411215 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2016 | ||||||||
| LastUpdateDate: | 08/09/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 1020601 | MA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.