Healthcare Provider Details

I. General information

NPI: 1568920361
Provider Name (Legal Business Name): KRISTEN CUMMINGS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2019
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 SUSSEX ST
PORT JERVIS NY
12771-2430
US

IV. Provider business mailing address

38 HOMESTEAD LN
OTISVILLE NY
10963-2106
US

V. Phone/Fax

Practice location:
  • Phone: 845-856-6344
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number104457
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: