Provider Demographics
NPI:1447466305
Name:CYR, DANYELLE MARIE (LCPC)
Entity type:Individual
Prefix:MRS
First Name:DANYELLE
Middle Name:MARIE
Last Name:CYR
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:FORT FAIRFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04742-3238
Mailing Address - Country:US
Mailing Address - Phone:207-551-7243
Mailing Address - Fax:
Practice Address - Street 1:20 OLD VAN BUREN RD
Practice Address - Street 2:
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-3430
Practice Address - Country:US
Practice Address - Phone:207-492-1130
Practice Address - Fax:207-492-1139
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC2240101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432106699Medicaid