=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972488419
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GERYL LYNN CUNNINGHAM LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2025
-----------------------------------------------------
Last Update Date | 08/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9280 S KYRENE RD STE 119
-----------------------------------------------------
City | TEMPE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85284-2954
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-339-7119
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 718 W CURRY ST
-----------------------------------------------------
City | CHANDLER
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85225-1818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-890-8810
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | LMSW-22893
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------