Provider Demographics
NPI:1548004567
Name:CUNNINGHAM, SARA (PHD)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 DANBY RD STE 202F
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-5714
Mailing Address - Country:US
Mailing Address - Phone:607-260-3100
Mailing Address - Fax:
Practice Address - Street 1:15 CORNELL RD STE 2
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1490
Practice Address - Country:US
Practice Address - Phone:518-510-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026342103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling