Provider Demographics
NPI:1528542057
Name:KELLY E BUNT LCSW PC
Entity Type:Organization
Organization Name:KELLY E BUNT LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNT BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:845-867-4926
Mailing Address - Street 1:80 WASHINGTON ST STE 305
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-2321
Mailing Address - Country:US
Mailing Address - Phone:845-867-4926
Mailing Address - Fax:845-905-2434
Practice Address - Street 1:80 WASHINGTON ST STE 305
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-2316
Practice Address - Country:US
Practice Address - Phone:845-867-4926
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-20
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health