Healthcare Provider Details

I. General information

NPI: 1962920694
Provider Name (Legal Business Name): JESSICA CUNNINGHAM LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2017
Last Update Date: 03/28/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 N MAIN ST
UNION BRIDGE MD
21791-9102
US

IV. Provider business mailing address

327 BROADWAY
HANOVER PA
17331-2505
US

V. Phone/Fax

Practice location:
  • Phone: 443-541-4300
  • Fax:
Mailing address:
  • Phone: 443-541-4300
  • Fax: 443-541-4300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number30510
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: