Provider Demographics
NPI:1245242692
Name:GUNN, JUDY LEE (MSW ACSW LMSW LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:LEE
Last Name:GUNN
Suffix:
Gender:F
Credentials:MSW ACSW LMSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N POMPANO BEACH BLVD
Mailing Address - Street 2:#511
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-5718
Mailing Address - Country:US
Mailing Address - Phone:248-219-3624
Mailing Address - Fax:
Practice Address - Street 1:101 SE 3RD AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-1920
Practice Address - Country:US
Practice Address - Phone:954-463-2273
Practice Address - Fax:954-779-1643
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW93201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCT591AMedicare UPIN