Individual
MS. CYNTHIA JENELL MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
195 BAY 19TH ST, BROOKLYN, NY 11214-4761
(718) 253-1366
Mailing address
146 PIERREPONT ST APT 9B, BROOKLYN, NY 11201-2840
(347) 355-3768
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
751414696
DRIVERS LICENSE
NY
Enumeration date
08/02/2018
Last updated
02/02/2022
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