Provider Demographics
NPI:1023492675
Name:SEASIDE PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:SEASIDE PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:401-239-6895
Mailing Address - Street 1:117 BELLEVUE AVE
Mailing Address - Street 2:SUITE 201D
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-7439
Mailing Address - Country:US
Mailing Address - Phone:401-239-6895
Mailing Address - Fax:401-849-3659
Practice Address - Street 1:117 BELLEVUE AVE
Practice Address - Street 2:SUITE 201D
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-7439
Practice Address - Country:US
Practice Address - Phone:401-239-6895
Practice Address - Fax:401-849-3659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty