| Organization Name: | SEASIDE PSYCHOLOGICAL SERVICES, LLC |
| NPI Number: | 1003281361 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHRISTOPHER CUNNINGHAM (CLINICAL PSYCHOLOGIST/OWNER) |
| Mailing Address: | 117 Bellevue Ave 201d Newport |
| State: | RI US |
| Postal Code: | 028407439 |
| Phone Number: | 4012396895 |
| Fax Number: | 4018493659 |
| NPI Enumeration Date: | 12/11/2015 |
| NPI Last Update Date: | 12/11/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PS01410 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | RI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |