Provider Demographics
NPI:1477604064
Name:CUNNINGHAM, PAMELA ANN (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:ANN
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:ANN
Other - Last Name:BUDNIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:400 STONY BROOK CT
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-6522
Mailing Address - Country:US
Mailing Address - Phone:845-565-0600
Mailing Address - Fax:866-733-1910
Practice Address - Street 1:400 STONY BROOK CT
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-6522
Practice Address - Country:US
Practice Address - Phone:845-565-0600
Practice Address - Fax:866-733-1910
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0783721041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400054810Medicare PIN