Healthcare Provider Details

I. General information

NPI: 1316119894
Provider Name (Legal Business Name): MARIA T CUNIO PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 MERRIMACK ST STE 502
LOWELL MA
01852-1729
US

IV. Provider business mailing address

45 MERRIMACK ST STE 502
LOWELL MA
01852-1729
US

V. Phone/Fax

Practice location:
  • Phone: 978-452-7038
  • Fax: 978-452-7008
Mailing address:
  • Phone: 978-452-7038
  • Fax: 978-452-7008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number7701
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number7701
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: