1144601931 NPI number — MS. ROSEANNA P CYR MA, MT-BC, LMHC, LPC

Table of content: MS. ROSEANNA P CYR MA, MT-BC, LMHC, LPC (NPI 1144601931)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144601931 NPI number — MS. ROSEANNA P CYR MA, MT-BC, LMHC, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CYR
Provider First Name:
ROSEANNA
Provider Middle Name:
P
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA, MT-BC, LMHC, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144601931
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2811 MONROE ST
Provider Second Line Business Mailing Address:
APT 1E
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53711-1859
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-839-5518
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2811 MONROE ST
Provider Second Line Business Practice Location Address:
APT 1E
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53711-1859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-839-5518
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  000008714 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 5694-125 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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