MEDICARE: PRISCILLA KUNKEL 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
1	1041C0700X	Clinical Social Worker	SW10549	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679841696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRISCILLA KUNKEL LCSW

Provider Business Mailing Address
First Line	:	2310 CHINOOK TRL
Second Line	:
City	:	MAITLAND
State	:	FL
Zip	:	32751-4080
Country	:	US
Telephone Number	:	203-610-1585
Fax Number	:	407-442-3710

Provider Business Practice Location Address
First Line	:	236 PASADENA PL
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-3828
Country	:	US
Telephone Number	:	321-594-8815
Fax Number	:	407-442-3710

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2011
Last Update Date	:	10/18/2022

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