Healthcare Provider Details

I. General information

NPI: 1841871795
Provider Name (Legal Business Name): MONIQUE CUNNINGHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 S OYSTER BAY RD
HICKSVILLE NY
11801-3510
US

IV. Provider business mailing address

950 S OYSTER BAY RD
HICKSVILLE NY
11801-3510
US

V. Phone/Fax

Practice location:
  • Phone: 631-521-8524
  • Fax:
Mailing address:
  • Phone: 631-521-8524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: