Provider Demographics
NPI:1982143277
Name:CUNNINGHAM, KERRI (MS, BCBA, LABA)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:MS, BCBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 NEWBURY STREET
Mailing Address - Street 2:STE 400
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:73 NEWBURY ST
Practice Address - Street 2:STE 400
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3042
Practice Address - Country:US
Practice Address - Phone:617-839-3707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1635103K00000X
MA1-16-24441103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst