Provider Demographics
NPI:1275565046
Name:SUTKIN, LAFAYE CUNNINGHAM
Entity Type:Individual
Prefix:DR
First Name:LAFAYE
Middle Name:CUNNINGHAM
Last Name:SUTKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:ALINE
Other - Middle Name:LAFAYE
Other - Last Name:SUTKIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:537 CAJON ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5903
Mailing Address - Country:US
Mailing Address - Phone:909-798-7267
Mailing Address - Fax:909-335-2477
Practice Address - Street 1:537 CAJON ST
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5903
Practice Address - Country:US
Practice Address - Phone:909-798-7267
Practice Address - Fax:909-335-2477
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2010-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 6306103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical