Provider Demographics
NPI:1003366832
Name:CUMMINGS, JEREMY (PHD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 3RD ST NW STE 212
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4094
Mailing Address - Country:US
Mailing Address - Phone:863-299-7787
Mailing Address - Fax:863-299-7757
Practice Address - Street 1:301 3RD ST NW STE 212
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4094
Practice Address - Country:US
Practice Address - Phone:863-299-7787
Practice Address - Fax:863-299-7757
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-05
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 9400103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist