Provider Demographics
NPI:1629525498
Name:CUNNINGHAM, RACHEL (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:RACHEL
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 JUNIPER RD
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-3131
Mailing Address - Country:US
Mailing Address - Phone:631-469-4428
Mailing Address - Fax:
Practice Address - Street 1:270 JUNIPER RD
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-3131
Practice Address - Country:US
Practice Address - Phone:631-469-4428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY098075104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker