Provider Demographics
NPI:1437180163
Name:CUMMINGS, PETER ROBERT (LCSW)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:ROBERT
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4204 DEL MAR AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-3640
Mailing Address - Country:US
Mailing Address - Phone:619-993-3692
Mailing Address - Fax:619-224-0584
Practice Address - Street 1:4452 PARK BLVD STE 304
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-4049
Practice Address - Country:US
Practice Address - Phone:619-993-3692
Practice Address - Fax:619-224-0584
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS112741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical