Provider Demographics
NPI:1144376344
Name:CUNNINGHAM PSYCHIATRIC GROUP
Entity Type:Organization
Organization Name:CUNNINGHAM PSYCHIATRIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-759-3477
Mailing Address - Street 1:4419 VAN NUYS BLVD
Mailing Address - Street 2:#407
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-2910
Mailing Address - Country:US
Mailing Address - Phone:818-759-3477
Mailing Address - Fax:
Practice Address - Street 1:4419 VAN NUYS BLVD
Practice Address - Street 2:#407
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2910
Practice Address - Country:US
Practice Address - Phone:818-759-3477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG074783101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14482Medicare ID - Type Unspecified