Provider Demographics
NPI:1275173502
Name:CUNNINGHAM, PATRICIA MARIE (MS)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MARIE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1096 53RD ST APT A
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-3029
Mailing Address - Country:US
Mailing Address - Phone:415-999-6439
Mailing Address - Fax:
Practice Address - Street 1:1096 53RD ST APT A
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94608-3029
Practice Address - Country:US
Practice Address - Phone:415-999-6439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA15557101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health