Provider Demographics
NPI:1316044506
Name:CUNNINGHAM, WILLIAM LAWTHER (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LAWTHER
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1085 US RTE 4E
Mailing Address - Street 2:STE 2A
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701
Mailing Address - Country:US
Mailing Address - Phone:802-775-6331
Mailing Address - Fax:802-775-6373
Practice Address - Street 1:1085 US RTE 4E
Practice Address - Street 2:STE 2A EASTRIDGE PROFESSIONAL BUILDING
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701
Practice Address - Country:US
Practice Address - Phone:802-775-6331
Practice Address - Fax:802-775-6373
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0480000196103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
69861OtherCIGNA
VT1006438Medicaid
41507OtherMVP