Provider Demographics
NPI:1932544145
Name:CUMMINS, STANLEY EDWARD (LISW-S)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:EDWARD
Last Name:CUMMINS
Suffix:
Gender:M
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 N CHESTERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-3634
Mailing Address - Country:US
Mailing Address - Phone:614-285-8482
Mailing Address - Fax:
Practice Address - Street 1:249 N CHESTERFIELD RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-3634
Practice Address - Country:US
Practice Address - Phone:614-285-8482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0007696-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical