Healthcare Provider Details

I. General information

NPI: 1033785043
Provider Name (Legal Business Name): WINIFRED H CUNNINGHAM MSW, LSW, LCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 06/01/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 FOREST AVE
PARAMUS NJ
07652-5241
US

IV. Provider business mailing address

111B GLENWOOD AVE
ELMWOOD PARK NJ
07407-1734
US

V. Phone/Fax

Practice location:
  • Phone: 201-880-7530
  • Fax: 201-880-7529
Mailing address:
  • Phone: 973-980-1137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWGTL2001945
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00330100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: