Individual
MR. TIMOTHY LEE CUNNINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
141 E MAIN ST, WATERBURY CLINICAL SERVICES, WATERBURY, CT 06702-2310
(203) 756-7287
(203) 236-0122
Mailing address
141 E MAIN ST, 4TH FLOOR ADMINISTRATION, WATERBURY, CT 06702-2310
(203) 574-9000
(203) 574-9006
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
000073
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008037428
—
CT
01
—
060669107
UBH/CONNECTICARE WELLMORE GRP/FACILITY
CT
01
—
11241824
CAQH
CT
01
—
390290
MHN-TRICARENORTH
CT
01
—
4853958
CIGNA BEHAVIORAL HEALTH
CT
01
—
9790693
AETNA BEHAVIORAL HEALTH
CT
01
—
D339123 WATERBURY
BEACON HEALTH STRATEGIES WELLMORE GRP/FACILITY
CT
Enumeration date
11/12/2008
Last updated
07/26/2016
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