Provider Demographics
NPI:1356336333
Name:HARTDEGEN, CYNTHIA PAYSON (MSW)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:PAYSON
Last Name:HARTDEGEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 DAY AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-3716
Mailing Address - Country:US
Mailing Address - Phone:413-562-2626
Mailing Address - Fax:413-572-9068
Practice Address - Street 1:30 DAY AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-3716
Practice Address - Country:US
Practice Address - Phone:413-562-2626
Practice Address - Fax:413-572-9068
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1025161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA12917OtherHEALTH NEW ENGLAND
MA776686OtherTUFTS HEALTH PLAN
MAP01501OtherBLUECROSS/BLUE SHIELD
P01501Medicare ID - Type Unspecified