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General NPI Number Information
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NPI Number | 1538706759
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Entity Type | Individual
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Provider Name | BRYNA SARA CUNNINGHAM LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/06/2019
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Last Update Date | 11/29/2022
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Provider Practice Location Address
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Address Line | 1400 MAIN ST STE 101
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City | LOUISVILLE
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State | CO
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Zip | 80027-3046
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Country | US
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Telephone | 303-882-5448
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Fax |
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Provider Business Mailing Address
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Address Line | 4819 RAVEN RUN
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City | BROOMFIELD
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State | CO
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Zip | 80023-4638
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Country | US
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Telephone | 303-257-8875
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 359
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License Number State | CO
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