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General NPI Number Information
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NPI Number | 1679081269
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Entity Type | Individual
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Provider Name | JON CUNHA
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Gender | Male
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Dates
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Enumeration Date | 01/17/2018
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Last Update Date | 01/17/2018
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Provider Practice Location Address
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Address Line | 35 BEDFORD ST STE 17
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City | LEXINGTON
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State | MA
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Zip | 02420-4440
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Country | US
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Telephone | 781-530-4138
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Fax |
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Provider Business Mailing Address
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Address Line | 175 FLORENCE RD
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City | WALTHAM
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State | MA
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Zip | 02453-7605
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Country | US
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Telephone | 781-316-6974
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 10166
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License Number State | MA
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