Provider Demographics
NPI:1770821225
Name:CUMMINS, KEVIN (NYS)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:CUMMINS
Suffix:
Gender:M
Credentials:NYS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 CLERMONT AVE # 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-3304
Mailing Address - Country:US
Mailing Address - Phone:347-881-6954
Mailing Address - Fax:
Practice Address - Street 1:192 CLERMONT AVE # 1
Practice Address - Street 2:1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-3304
Practice Address - Country:US
Practice Address - Phone:347-881-6954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY843322642103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst