MEDICARE: MR. DARRICK DEWAYNE CUNNINGHAM M.S.W

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	1041C0700X	Clinical Social Worker	057808	NY

General Provider Information

NPI Number	:	1801870068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DARRICK DEWAYNE CUNNINGHAM M.S.W

Provider Business Mailing Address
First Line	:	2667 BLOOMSBERRY RIDGE DR
Second Line	:
City	:	FUQUAY VARINA
State	:	NC
Zip	:	27526-7292
Country	:	US
Telephone Number	:	919-567-2270
Fax Number	:

Provider Business Practice Location Address
First Line	:	51 MDOS/SGOH
Second Line	:
City	:	APO
State	:	AP
Zip	:	96266
Country	:	KR
Telephone Number	:	315-784-2149
Fax Number	:

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

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	07/08/2007

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