Provider Demographics
NPI:1104010271
Name:MUNGIN, BERNARD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:
Last Name:MUNGIN
Suffix:
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 1:3295 FOREST INN ROAD, SUITE 3
Mailing Address - Street 2:
Mailing Address - City:PALMERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18103-5300
Mailing Address - Country:US
Mailing Address - Phone:610-826-8482
Mailing Address - Fax:610-826-8483
Practice Address - Street 1:3295 FOREST INN ROAD, SUITE 3
Practice Address - Street 2:
Practice Address - City:PALMERTON
Practice Address - State:PA
Practice Address - Zip Code:18103-5300
Practice Address - Country:US
Practice Address - Phone:610-826-8482
Practice Address - Fax:610-826-8483
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW125501104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker