Provider Demographics
NPI:1477518249
Name:CUMELLA, EDWARD J (PHD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:CUMELLA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:51826 N MOCKINGBIRD TRL
Mailing Address - Street 2:
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85390-1586
Mailing Address - Country:US
Mailing Address - Phone:480-688-0708
Mailing Address - Fax:928-684-4594
Practice Address - Street 1:1 E APACHE ST
Practice Address - Street 2:
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-2442
Practice Address - Country:US
Practice Address - Phone:928-684-4572
Practice Address - Fax:928-684-4594
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ1859103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZR10386Medicare UPIN