Provider Demographics
NPI:1902061781
Name:TRUELL, CYNTHIA (NP, CASAC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:TRUELL
Suffix:
Gender:F
Credentials:NP, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10454-1199
Mailing Address - Country:US
Mailing Address - Phone:646-316-7477
Mailing Address - Fax:347-398-5804
Practice Address - Street 1:2367-69 SECOND AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035
Practice Address - Country:US
Practice Address - Phone:347-590-3047
Practice Address - Fax:347-590-8089
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY19691101YA0400X
NY401397363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01420795Medicaid