Provider Demographics
NPI:1679813711
Name:CUMMARO, JANET (MS, PSYD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:
Last Name:CUMMARO
Suffix:
Gender:F
Credentials:MS, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 RINGGOLD ST
Mailing Address - Street 2:
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-3309
Mailing Address - Country:US
Mailing Address - Phone:914-737-3300
Mailing Address - Fax:
Practice Address - Street 1:212 RINGGOLD ST
Practice Address - Street 2:
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-3309
Practice Address - Country:US
Practice Address - Phone:914-737-4542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
XXXXXXXXX103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001388290Medicaid