Provider Demographics
NPI:1861723447
Name:RADOVIC, CYNTHIA M (MA , BSN-BC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:M
Last Name:RADOVIC
Suffix:
Gender:F
Credentials:MA , BSN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11207A LOCKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4550
Mailing Address - Country:US
Mailing Address - Phone:301-518-1104
Mailing Address - Fax:
Practice Address - Street 1:11207A LOCKWOOD DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4550
Practice Address - Country:US
Practice Address - Phone:301-518-1104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR164917163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health