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General NPI Number Information
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NPI Number | 1801922745
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Entity Type | Individual
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Provider Name | GARY HERBERT CUNHA MSW, LCSW
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Gender | Male
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 06/17/2015
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Provider Practice Location Address
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Address Line | 508 FULTON ST (116)
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City | DURHAM
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State | NC
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Zip | 27705-3875
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Country | US
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Telephone | 919-286-0411
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Fax | 919-416-5832
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Provider Business Mailing Address
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Address Line | 45 RIVERWOOD DR
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City | FUQUAY VARINA
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State | NC
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Zip | 27526-5636
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Country | US
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Telephone | 919-577-6079
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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 | C002314
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License Number State | NC
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