Provider Demographics
NPI:1740432384
Name:CUNNINGHAM, EVELYN DIANE (ATR-BC, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:DIANE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:ATR-BC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-1704
Mailing Address - Country:US
Mailing Address - Phone:617-786-1242
Mailing Address - Fax:
Practice Address - Street 1:9 CANTON ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-2424
Practice Address - Country:US
Practice Address - Phone:781-986-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5777101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health