Provider Demographics
NPI:1992177703
Name:CUNNINGHAM, CHRYSTAL (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CHRYSTAL
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MS
Other - First Name:CHRYSTAL
Other - Middle Name:
Other - Last Name:YAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:1925 S PERIMETER RD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-7122
Mailing Address - Country:US
Mailing Address - Phone:954-958-0988
Mailing Address - Fax:
Practice Address - Street 1:2601 N ROCK ISLAND RD APT 105
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-1223
Practice Address - Country:US
Practice Address - Phone:954-242-8560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-20
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLW2206 31239Medicaid