Provider Demographics
NPI:1164899266
Name:BUNIN, JENNIFER LAINA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LAINA
Last Name:BUNIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BREWSTER ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-5806
Mailing Address - Country:US
Mailing Address - Phone:201-741-3814
Mailing Address - Fax:
Practice Address - Street 1:1150 PRESIDENT ST APT B1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-1736
Practice Address - Country:US
Practice Address - Phone:201-741-3814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0950711041C0700X
NY0820571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical