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General NPI Number Information
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NPI Number | 1518389147
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Entity Type | Individual
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Provider Name | MARY LOUISE CUNNIFFE MSW
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Gender | Female
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Dates
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Enumeration Date | 01/16/2014
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Last Update Date | 04/25/2023
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Provider Practice Location Address
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Address Line | 882 OAKMAN BLVD SUITE D
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City | DETROIT
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State | MI
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Zip | 48238-3710
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Country | US
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Telephone | 313-691-7990
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Fax |
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Provider Business Mailing Address
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Address Line | 120 CAMPBELL ST #8
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City | ROCHESTER
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State | MI
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Zip | 48307-2677
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Country | US
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Telephone | 248-238-5033
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6801092682
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801092682
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License Number State | MP
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801092682
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801092682
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License Number State | MI
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