Provider Demographics
NPI:1053167957
Name:CUNNINGHAM, TEVIN
Entity type:Individual
Prefix:
First Name:TEVIN
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:TEVIN
Other - Middle Name:
Other - Last Name:CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NOT APPLICABLE
Mailing Address - Street 1:33 RALPH AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-3711
Mailing Address - Country:US
Mailing Address - Phone:516-297-7023
Mailing Address - Fax:
Practice Address - Street 1:33 RALPH AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-3711
Practice Address - Country:US
Practice Address - Phone:516-297-7023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst