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NPI Code Detail

MEDICARE: MS. SUSAN J BUNIVA MSW, LCSW

MEDICARE: MS. SUSAN J BUNIVA MSW, LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker0904000874VA

General Provider Information

NPI Number : 1275727273
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SUSAN J BUNIVA MSW, LCSW
Provider Business Mailing Address
First Line : 3212 SKIPWITH RD STE 104
Second Line :
City : RICHMOND
State : VA
Zip : 23294-4413
Country : US
Telephone Number : 804-270-4111
Fax Number :
Provider Business Practice Location Address
First Line : 3212 SKIPWITH RD STE 104
Second Line :
City : RICHMOND
State : VA
Zip : 23294-4413
Country : US
Telephone Number : 804-270-4111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2007
Last Update Date : 09/02/2007

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