Provider Demographics
NPI:1730300393
Name:CUNNINGHAM, DOROTHY B (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:B
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 WEST 13TH STREET #5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-7746
Mailing Address - Country:US
Mailing Address - Phone:212-691-4471
Mailing Address - Fax:212-366-6145
Practice Address - Street 1:230 W. 13TH STREET #E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7746
Practice Address - Country:US
Practice Address - Phone:212-229-2311
Practice Address - Fax:212-366-6145
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7943-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6305OtherVALUE OPTIONS
NYV46481Medicaid
NY0033961OtherGHI
NYV46481Medicaid