Healthcare Provider Details

I. General information

NPI: 1104165182
Provider Name (Legal Business Name): SIOBHAN DEANN CUNNINGHAM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SIOBHAN GASS

II. Dates (important events)

Enumeration Date: 02/11/2013
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S COBB ST UNIT 2631
PALMER AK
99645-1140
US

IV. Provider business mailing address

500 S COBB ST UNIT 2631
PALMER AK
99645-1140
US

V. Phone/Fax

Practice location:
  • Phone: 561-573-6175
  • Fax:
Mailing address:
  • Phone: 561-573-6175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW11012
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number136666
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: