Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | PY6979 | FL |
N | 103G00000X | Clinical Psychologist | PY6979 | FL |
N | 103TC0700X | Clinical Psychologist | PY6979 | FL |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PY6979 | FL |
Y | 103TF0200X | Forensic Psychologist | PY6979 | FL |
N | 103TH0100X | Health Service | PY6979 | FL |
N | 103TP2701X | Group Psychotherapist | PY6979 | FL |
NPI | 1144698929 |
---|---|
Provider Name | Dr. Edward Cunliffe |
First Address | Lake Worth, FL 33460-3846 |
Second Address | Lake Worth, FL 33460-3846 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2015 |
Last Update Date | 10/09/2015 |