Provider Demographics
NPI:1023185402
Name:BUNN, THOMAS CADE JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:CADE
Last Name:BUNN
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 747
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06881-0747
Mailing Address - Country:US
Mailing Address - Phone:203-258-4803
Mailing Address - Fax:
Practice Address - Street 1:4 SPORT HILL RD
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:CT
Practice Address - Zip Code:06612-2228
Practice Address - Country:US
Practice Address - Phone:877-332-7359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0044001041C0700X
NY045523-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical