Provider Demographics
NPI:1225629801
Name:CUNHA, KELLY ANN (LICSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:CUNHA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WALTER ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-2523
Mailing Address - Country:US
Mailing Address - Phone:781-608-0101
Mailing Address - Fax:
Practice Address - Street 1:33 BATES RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-1299
Practice Address - Country:US
Practice Address - Phone:781-608-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0001221191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical