Provider Demographics
NPI:1265900922
Name:CUNNINGHAM, JAMAL RASHAD (MED, PSYD)
Entity type:Individual
Prefix:DR
First Name:JAMAL
Middle Name:RASHAD
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:MED, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 N CRAMER ST APT 21
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-3509
Mailing Address - Country:US
Mailing Address - Phone:301-922-3930
Mailing Address - Fax:
Practice Address - Street 1:1845 N FARWELL AVE STE 303B
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-1715
Practice Address - Country:US
Practice Address - Phone:872-216-2514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-10
Last Update Date:2018-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3611-57103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical