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General NPI Number Information
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NPI Number | 1144698929
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Entity Type | Individual
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Provider Name | EDWARD CUNLIFFE PHD
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Gender | Male
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Dates
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Enumeration Date | 09/10/2015
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Last Update Date | 09/10/2015
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Provider Practice Location Address
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Address Line | 521 LAKE AVE STE 8
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City | LAKE WORTH
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State | FL
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Zip | 33460-3846
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Country | US
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Telephone | 305-484-0832
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Fax | 305-668-7450
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Provider Business Mailing Address
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Address Line | 521 LAKE AVE STE 8
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City | LAKE WORTH
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State | FL
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Zip | 33460-3846
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Country | US
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Telephone | 305-484-0832
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Fax | 305-668-7450
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | PY6979
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY6979
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PY6979
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number | PY6979
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | PY6979
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License Number State | FL
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Taxonomy #6
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number | PY6979
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License Number State | FL
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