Provider Demographics
NPI:1871719021
Name:HARCOURT, CYNTHIA J (LCSW)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:J
Last Name:HARCOURT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46173-2208
Mailing Address - Country:US
Mailing Address - Phone:765-932-5905
Mailing Address - Fax:765-938-4545
Practice Address - Street 1:121 E 3RD ST
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IN
Practice Address - Zip Code:46173-2208
Practice Address - Country:US
Practice Address - Phone:765-932-5905
Practice Address - Fax:765-938-4545
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000767A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN711000AMedicare PIN