Provider Demographics
NPI:1568643633
Name:CUNNINGHAM, JOHN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 ELMONT RD
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-1603
Mailing Address - Country:US
Mailing Address - Phone:516-437-0440
Mailing Address - Fax:516-326-1159
Practice Address - Street 1:40 ELMONT RD
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-1603
Practice Address - Country:US
Practice Address - Phone:516-437-0440
Practice Address - Fax:516-326-1159
Is Sole Proprietor?:No
Enumeration Date:2007-11-17
Last Update Date:2007-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO27853-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical