=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649298241
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SANDRA S. DUNN MSW, LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10000 BAY PINES BLVD.
-----------------------------------------------------
City | SAINT PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33744
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-391-4994
-----------------------------------------------------
Fax | 727-319-1330
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12331 90TH AVE. NO.
-----------------------------------------------------
City | SEMINOLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33772
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-391-4994
-----------------------------------------------------
Fax | 727-319-1330
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 1070
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------