Provider Demographics
NPI:1972780005
Name:CUNNINGHAM, JEAN M (LCSW)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:M
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:M
Other - Last Name:DONOVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:540 LITCHFILED STREET
Mailing Address - Street 2:C/O IRENE BENZA
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-6679
Mailing Address - Country:US
Mailing Address - Phone:860-496-6361
Mailing Address - Fax:860-496-6389
Practice Address - Street 1:540 LITCHFILED STREET
Practice Address - Street 2:C/O IRENE BENZA
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6679
Practice Address - Country:US
Practice Address - Phone:860-496-6361
Practice Address - Fax:860-496-6389
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0068651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical