Provider Demographics
NPI:1760037246
Name:CUNNINGHAM, MARY BURKE (MA, EDM, LPC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:BURKE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:MA, EDM, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 EVERGREEN PL
Mailing Address - Street 2:
Mailing Address - City:ROSELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07068-1224
Mailing Address - Country:US
Mailing Address - Phone:973-651-8730
Mailing Address - Fax:
Practice Address - Street 1:7 EVERGREEN PL
Practice Address - Street 2:
Practice Address - City:ROSELAND
Practice Address - State:NJ
Practice Address - Zip Code:07068-1224
Practice Address - Country:US
Practice Address - Phone:973-651-8730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00022200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health