MEDICARE: LAURISA CUMMINGS MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6801090586	MI

General Provider Information

NPI Number	:	1619334828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURISA CUMMINGS MSW

Provider Business Mailing Address
First Line	:	248 WASHINGTON AVE
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708-5848
Country	:	US
Telephone Number	:	989-892-5664
Fax Number	:

Provider Business Practice Location Address
First Line	:	248 WASHINGTON AVE
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708-5848
Country	:	US
Telephone Number	:	989-892-5664
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2016
Last Update Date	:	01/19/2016

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