Provider Demographics
NPI:1033468657
Name:CUNNINGHAM, DANIEL W (PSYD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:W
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 N CATALINA AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-2301
Mailing Address - Country:US
Mailing Address - Phone:626-676-0701
Mailing Address - Fax:562-431-8875
Practice Address - Street 1:65 N CATALINA AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2301
Practice Address - Country:US
Practice Address - Phone:626-676-0701
Practice Address - Fax:562-431-8875
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25145103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical