Provider Demographics
NPI:1407123300
Name:BUJNICKI, KELLY (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:BUJNICKI
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 1:923 SE 20TH CT
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-1850
Mailing Address - Country:US
Mailing Address - Phone:413-433-4042
Mailing Address - Fax:
Practice Address - Street 1:923 SE 20TH CT
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-1850
Practice Address - Country:US
Practice Address - Phone:413-433-4042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-20
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL218841041C0700X
MA1144111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical