Provider Demographics
NPI:1447260377
Name:GAWARECKI, CYNTHIA CAROL
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:CAROL
Last Name:GAWARECKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1169 EASTERN PKWY STE 1149
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1462
Mailing Address - Country:US
Mailing Address - Phone:502-432-3229
Mailing Address - Fax:502-688-5098
Practice Address - Street 1:1169 EASTERN PKWY STE 1149
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1462
Practice Address - Country:US
Practice Address - Phone:502-432-3229
Practice Address - Fax:502-688-5098
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2022-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY304952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYG58945Medicare UPIN
KY0046789Medicare ID - Type Unspecified