Channon M Cunningham, MSW, LCSW, CAC/CCDP

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CW014860 Issued in PA

Practice address

460 Market St
Ste 114
Williamsport, PA 17701-6321

Phone

(570) 212-9481

NPI assigned

Jan 3, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lycoming Therapeutic Wrap Around Services, Inc

  • Clinical Psychologist
  • Williamsport, PA
  • NPI 1831245570
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1136246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603756800000",
    "number": "1023096856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "460 MARKET ST",
            "address_2": "STE 114",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177016321",
            "telephone_number": "570-212-9481",
            "fax_number": "570-651-9250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "460 MARKET ST",
            "address_2": "STE 114",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177016321",
            "telephone_number": "570-212-9481"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "301 W Grove St Ste 10",
            "address_purpose": "LOCATION",
            "city": "Clarks Summit",
            "state": "PA",
            "postal_code": "18411",
            "country_code": "US",
            "telephone_number": "570-212-9481",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CUNNINGHAM",
        "first_name": "CHANNON",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "MSW, LCSW, CAC/CCDP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-03",
        "last_updated": "2020-10-27",
        "certification_date": "2020-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "PA",
            "license": "CW014860",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "1362328",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Crouse-Novak, LCSW
• Thomas Edward Cullen, D.O.
• Marie Cummings, MS
• Quinn Addison Cummings
• Jeffrey Cundiff
• Amy Curry, D.O.
• Gerald F Cusimano, CRNA
• Rebekah Cygan, PTA
• Allison Czap, PT, DPT
• Rose Czap

• Clinical Social Worker in Williamsport, PA
• Providers in Williamsport, PA by specialty
• Clinical Social Worker in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.