Provider Demographics
NPI:1043656127
Name:LEACH, CYNTHIA ELIZABETH (MSW, LCSW, LMFT)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:ELIZABETH
Last Name:LEACH
Suffix:
Gender:F
Credentials:MSW, LCSW, LMFT
Other - Prefix:MS
Other - First Name:C.
Other - Middle Name:ELIZABETH
Other - Last Name:LEACH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW, LMFT
Mailing Address - Street 1:4 PINEKNOLL DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-3138
Mailing Address - Country:US
Mailing Address - Phone:609-610-5011
Mailing Address - Fax:
Practice Address - Street 1:390 AMWELL RD BLDG 3
Practice Address - Street 2:SUITE NUMBER 312
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-1225
Practice Address - Country:US
Practice Address - Phone:609-610-5011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051884-1104100000X
NJ44SC054275001041C0700X
FLSW55741041C0700X
NJ37F100169200106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist