Provider Demographics
NPI:1194525022
Name:CUNNINGHAM, NATHANIEL (LP)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 DRIGGS AVE APT 2L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-2956
Mailing Address - Country:US
Mailing Address - Phone:347-244-3947
Mailing Address - Fax:
Practice Address - Street 1:244 5TH AVE FL 10
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-7932
Practice Address - Country:US
Practice Address - Phone:347-244-3947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001247102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst