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General NPI Number Information
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NPI Number | 1376433623
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Entity Type | Individual
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Provider Name | JACQUELINE KAY CUNCANNAN LMSW
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Gender | Female
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Dates
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Enumeration Date | 07/08/2025
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 1655 FORT MYER DR
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City | ARLINGTON
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State | VA
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Zip | 22209-3113
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Country | US
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Telephone | 202-670-7724
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Fax |
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Provider Business Mailing Address
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Address Line | 2250 N VERNON ST
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City | ARLINGTON
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State | VA
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Zip | 22207-4049
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Country | US
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Telephone | 202-669-3629
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 0903004561
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License Number State | VA
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