Provider Demographics
NPI:1275727273
Name:BUNIVA, SUSAN J (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:J
Last Name:BUNIVA
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 SKIPWITH RD STE 104
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4413
Mailing Address - Country:US
Mailing Address - Phone:804-270-4111
Mailing Address - Fax:
Practice Address - Street 1:3212 SKIPWITH RD STE 104
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4413
Practice Address - Country:US
Practice Address - Phone:804-270-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-02
Last Update Date:2007-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040008741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical