Provider Demographics
NPI:1881753721
Name:CUNNINGHAM, CHRISTINE MARGUERITE (LICSW,LADC)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:MARGUERITE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:LICSW,LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 NEWTONVILLE AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEWTONVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02460
Mailing Address - Country:US
Mailing Address - Phone:617-969-8293
Mailing Address - Fax:617-969-8293
Practice Address - Street 1:1171 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WEST NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02465
Practice Address - Country:US
Practice Address - Phone:617-899-3932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA113000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO8701OtherBCBS
MAPO8701OtherBCBS