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General NPI Number Information
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NPI Number | 1639614217
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Entity Type | Organization
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Legal Business Name | LINDA J. BUNCK LCSW
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Dates
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Enumeration Date | 01/05/2017
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Last Update Date | 01/05/2017
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Provider Practice Location Address
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Address Line | 1342 COLONIAL BLVD SUITE K-119
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City | FORT MYERS
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State | FL
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Zip | 33907-1013
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Country | US
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Telephone | 239-910-0955
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Fax |
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Provider Business Mailing Address
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Address Line | 3927 SE 4TH AVE
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City | CAPE CORAL
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State | FL
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Zip | 33904-4830
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Country | US
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Telephone | 239-910-0955
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | LINDA J BUNCK
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Credential | LCSW
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Telephone | 239-910-0955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | SW5026
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License Number State | FL
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