Provider Demographics
NPI:1710277959
Name:CUNNINGHAM, AMYLYNN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AMYLYNN
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 PARKER AVE
Mailing Address - Street 2:APARTMENT A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-4443
Mailing Address - Country:US
Mailing Address - Phone:215-593-0172
Mailing Address - Fax:
Practice Address - Street 1:105 BALA AVE
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3307
Practice Address - Country:US
Practice Address - Phone:215-593-0172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016959103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical