Provider Demographics
NPI:1336130269
Name:CUNNINGHAM, KATHLEEN ANN (MA MSW LCSW BCD)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ANN
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:MA MSW LCSW BCD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:A
Other - Last Name:VERRENGIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA MSW LCSW BCD
Mailing Address - Street 1:2550 MOSSIDE BLVD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146
Mailing Address - Country:US
Mailing Address - Phone:412-373-3471
Mailing Address - Fax:412-373-7324
Practice Address - Street 1:2550 MOSSIDE BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146
Practice Address - Country:US
Practice Address - Phone:412-373-3471
Practice Address - Fax:412-373-7324
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW013031104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA065975Medicare ID - Type Unspecified