Provider Demographics
NPI:1629349279
Name:CUMMINGS, MORGAN JAY (LADC)
Entity Type:Individual
Prefix:MR
First Name:MORGAN
Middle Name:JAY
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 BROAD ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4036
Mailing Address - Country:US
Mailing Address - Phone:860-643-3210
Mailing Address - Fax:
Practice Address - Street 1:335 BROAD ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4036
Practice Address - Country:US
Practice Address - Phone:860-643-3210
Practice Address - Fax:860-643-3211
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000918101YA0400X
CT0087741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)