MEDICARE: JENNIFER CUNNINGHAM LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	0755471	NY

General Provider Information

NPI Number	:	1255408738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER CUNNINGHAM LCSW

Provider Business Mailing Address
First Line	:	PO BOX 3001
Second Line	:	998 CROOKED HILL RD BUILDING #5
City	:	BRENTWOOD
State	:	NY
Zip	:	11717-3001
Country	:	US
Telephone Number	:	631-329-0373
Fax Number	:	631-907-9345

Provider Business Practice Location Address
First Line	:	287 SPRINGS FIREPLACE RD
Second Line	:	BOX 3067
City	:	EAST HAMPTON
State	:	NY
Zip	:	11937-4823
Country	:	US
Telephone Number	:	631-329-0373
Fax Number	:	631-907-9345

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	06/27/2012

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