Healthcare Provider Details

I. General information

NPI: 1861505943
Provider Name (Legal Business Name): DENISE NICOLE MIO- CUNNINGHAM ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 EL CAMINO AVE
CARMICHAEL CA
95608-4650
US

IV. Provider business mailing address

5030 EL CAMINO AVE
CARMICHAEL CA
95608-4650
US

V. Phone/Fax

Practice location:
  • Phone: 916-609-5100
  • Fax: 916-226-2804
Mailing address:
  • Phone: 916-282-1937
  • Fax: 916-282-1940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17772
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: