Healthcare Provider Details

I. General information

NPI: 1619930906
Provider Name (Legal Business Name): ANDREW LYON KUMIN PSY. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SALEM GRN SUITE 400
SALEM MA
01970-3724
US

IV. Provider business mailing address

1 SALEM GRN SUITE 400
SALEM MA
01970-3724
US

V. Phone/Fax

Practice location:
  • Phone: 978-745-1555
  • Fax: 978-745-9555
Mailing address:
  • Phone: 978-745-1555
  • Fax: 978-745-9555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number7099
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: