Provider Demographics
NPI:1114209046
Name:CUMMINGS, MIRIAM M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:M
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:PAINTED POST
Mailing Address - State:NY
Mailing Address - Zip Code:14870-1100
Mailing Address - Country:US
Mailing Address - Phone:607-936-3704
Mailing Address - Fax:
Practice Address - Street 1:16 BEARTOWN RD
Practice Address - Street 2:
Practice Address - City:PAINTED POST
Practice Address - State:NY
Practice Address - Zip Code:14870-9320
Practice Address - Country:US
Practice Address - Phone:607-936-6514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0707321041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool