Individual
BRIAN CUNNINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CASAC-T
Contact information
Practice address
1444 5TH AVE, BAY SHORE, NY 11706-4147
(631) 647-3113
Mailing address
76 CHURCH AVE, ISLIP, NY 11751-3902
(631) 449-0892
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
31718
NY
Other
Enumeration date
11/08/2016
Last updated
11/08/2016
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