Provider Demographics
NPI:1659000370
Name:CUNNINGHAM, RODNEY HERVAE SR
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:HERVAE
Last Name:CUNNINGHAM
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4721 READING RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-6199
Mailing Address - Country:US
Mailing Address - Phone:513-242-7600
Mailing Address - Fax:
Practice Address - Street 1:4721 READING RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-6199
Practice Address - Country:US
Practice Address - Phone:513-242-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00000Medicaid