Provider Demographics
NPI:1598783391
Name:CUNNINGHAM, LAURA ANN B (LISW)
Entity Type:Individual
Prefix:
First Name:LAURA ANN
Middle Name:B
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-3202
Mailing Address - Country:US
Mailing Address - Phone:216-459-9827
Mailing Address - Fax:216-696-5638
Practice Address - Street 1:3518 W 25TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1951
Practice Address - Country:US
Practice Address - Phone:216-459-9827
Practice Address - Fax:216-459-9821
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.102651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical