Provider Demographics
NPI:1073028023
Name:CUNEO, JODI RALYN (PHD)
Entity type:Individual
Prefix:DR
First Name:JODI
Middle Name:RALYN
Last Name:CUNEO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38400 N SCHOOLHOUSE ROAD
Mailing Address - Street 2:7428
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85327
Mailing Address - Country:US
Mailing Address - Phone:609-254-7737
Mailing Address - Fax:
Practice Address - Street 1:5060 N 19TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-3211
Practice Address - Country:US
Practice Address - Phone:609-254-7737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4887103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty