Provider Demographics
NPI:1699397091
Name:CUNKELMAN, LAUREN SUSANNA (MA, R-DMT, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:SUSANNA
Last Name:CUNKELMAN
Suffix:
Gender:F
Credentials:MA, R-DMT, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:255 LOWRYS LN APT 10
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1316
Mailing Address - Country:US
Mailing Address - Phone:724-575-3465
Mailing Address - Fax:
Practice Address - Street 1:3905 FORD RD STE 6
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-2824
Practice Address - Country:US
Practice Address - Phone:215-220-2192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012072101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional