Provider Demographics
NPI:1942688700
Name:CUNNINGHAM, JOANNA MARIE (MS BCBA)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:MARIE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:MS BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 RESERVOIR RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-8710
Mailing Address - Country:US
Mailing Address - Phone:570-371-8323
Mailing Address - Fax:
Practice Address - Street 1:17 RESERVOIR RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-8710
Practice Address - Country:US
Practice Address - Phone:570-371-8323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-15-18207103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst