MEDICARE: SAMANTHA C 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	101YM0800X	Mental Health Counselor	LH60630652	WA
2	1041C0700X	Clinical Social Worker	L7991	OR
3	1041C0700X	Clinical Social Worker	LW61371985	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386195139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA C CUNNINGHAM LCSW

Provider Business Mailing Address
First Line	:	10920 SW BARBUR BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97219-8600
Country	:	US
Telephone Number	:	541-687-1110
Fax Number	:

Provider Business Practice Location Address
First Line	:	10920 SW BARBUR BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97219-8600
Country	:	US
Telephone Number	:	541-687-1110
Fax Number	:

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

Provider Enumeration Date	:	10/17/2016
Last Update Date	:	02/17/2026

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