Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PY 9400 | FL |
Y | 103T00000X | Psychologist | PY 9400 | FL |
NPI | 1003366832 |
---|---|
Provider Name | Jeremy Cummings |
First Address | Lakeland, FL 33803-7947 |
Second Address | Lakeland, FL 33813-2623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2016 |
Last Update Date | 05/10/2016 |