Provider Demographics
NPI:1538394648
Name:FATA, CYNTHIA (MA)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:
Last Name:FATA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 KILAUEA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4272
Mailing Address - Country:US
Mailing Address - Phone:808-854-0436
Mailing Address - Fax:
Practice Address - Street 1:614 KILAUEA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4272
Practice Address - Country:US
Practice Address - Phone:808-854-0436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMHC 358101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health