Provider Demographics
NPI:1710870050
Name:CUMMINGS, JERREL A
Entity type:Individual
Prefix:
First Name:JERREL
Middle Name:A
Last Name:CUMMINGS
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 1:27 ELD ST APT F
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-3823
Mailing Address - Country:US
Mailing Address - Phone:203-705-9237
Mailing Address - Fax:
Practice Address - Street 1:109 LEGION AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-5506
Practice Address - Country:US
Practice Address - Phone:203-562-2264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008220104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker