Provider Demographics
NPI:1447722186
Name:MARBLE, CYNTHIA LYNN (MA, LCMHC, LADC)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:LYNN
Last Name:MARBLE
Suffix:
Gender:F
Credentials:MA, LCMHC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 WAYLAND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4314
Mailing Address - Country:US
Mailing Address - Phone:802-257-2415
Mailing Address - Fax:802-251-0030
Practice Address - Street 1:300 MAPLE ST STE 201
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6512
Practice Address - Country:US
Practice Address - Phone:802-257-2415
Practice Address - Fax:802-251-0030
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT151.0126994101YA0400X
VT068.0000733101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)