Provider Demographics
NPI:1922252352
Name:CUNNINGHAM, TIMOTHY LEE
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:LEE
Last Name:CUNNINGHAM
Suffix:
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 1:141 E MAIN ST
Mailing Address - Street 2:4TH FLOOR ADMINISTRATION
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702-2310
Mailing Address - Country:US
Mailing Address - Phone:203-574-9000
Mailing Address - Fax:203-574-9006
Practice Address - Street 1:141 E MAIN ST
Practice Address - Street 2:WATERBURY CLINICAL SERVICES
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-2310
Practice Address - Country:US
Practice Address - Phone:203-756-7287
Practice Address - Fax:203-236-0122
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000073101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060669107OtherUBH/CONNECTICARE WELLMORE GRP/FACILITY
CT060669107OtherUBH/OPTUM BEHAVIORAL HEALTH WELLMORE GRP/FACILITY
CT008037428Medicaid
CT060669107OtherANTHEM BCBS OF CT WELLMORE GRP/FACILITY
CT4853958OtherCIGNA BEHAVIORAL HEALTH
CT9790693OtherAETNA BEHAVIORAL HEALTH
CT060669107OtherUBH/LIBERTY FREEDOM WELLMORE GRP/FACILITY
CT390290OtherMHN-TRICARENORTH
CT11241824OtherCAQH
CT390290OtherMHN- MANAGED HEALTH NETWORK
CTD339123 WATERBURYOtherBEACON HEALTH STRATEGIES WELLMORE GRP/FACILITY
CT060669107OtherHEALTHYCT WELLMORE GRP/FACILITY
CT060669107OtherUBH/UNITED HEALTHCARE WELLMORE GRP/FACILITY
CT9790693OtherAETNA BEHAVIORAL HEALTH