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General NPI Number Information
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NPI Number | 1073028023
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Entity Type | Individual
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Provider Name | JODI RALYN CUNEO PH.D.
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Gender | Female
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Dates
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Enumeration Date | 12/12/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 5060 N 19TH AVE STE 101
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City | PHOENIX
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State | AZ
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Zip | 85015-3211
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Country | US
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Telephone | 609-254-7737
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Fax |
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Provider Business Mailing Address
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Address Line | 38400 N SCHOOLHOUSE ROAD 7428
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City | CAVE CREEK
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State | AZ
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Zip | 85327
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Country | US
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Telephone | 609-254-7737
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 4887
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License Number State | AZ
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