Provider Demographics
NPI:1174735567
Name:KYRIAKOPOULOS-CUNNINGHAM, POLYXENI (PSYD)
Entity type:Individual
Prefix:DR
First Name:POLYXENI
Middle Name:
Last Name:KYRIAKOPOULOS-CUNNINGHAM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:POLYXENI
Other - Middle Name:
Other - Last Name:KYRIAKOPOULOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:33 PRATT ST
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-1014
Mailing Address - Country:US
Mailing Address - Phone:860-214-9458
Mailing Address - Fax:860-430-6861
Practice Address - Street 1:33 PRATT ST
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1014
Practice Address - Country:US
Practice Address - Phone:860-214-9458
Practice Address - Fax:860-430-6861
Is Sole Proprietor?:No
Enumeration Date:2007-05-06
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002889103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical