Provider Demographics
NPI:1811506918
Name:CUNNINGHAM, MAKAYLA T (LCSW)
Entity type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:T
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 S WARNER RD STE 310
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-2860
Mailing Address - Country:US
Mailing Address - Phone:215-298-2511
Mailing Address - Fax:
Practice Address - Street 1:150 S WARNER RD STE 310
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2860
Practice Address - Country:US
Practice Address - Phone:866-659-1177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-24
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0098361041C0700X
RIISW026231041C0700X
PACW0211981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical