Provider Demographics
NPI:1336882893
Name:CUMMINGS, JUSTIN RYAN (PH D, LMFT, CAP)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:RYAN
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:PH D, LMFT, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15835 SW 52ND ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4978
Mailing Address - Country:US
Mailing Address - Phone:786-459-1017
Mailing Address - Fax:
Practice Address - Street 1:15835 SW 52ND ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4978
Practice Address - Country:US
Practice Address - Phone:786-459-1017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3788106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist