Provider Demographics
NPI:1548769235
Name:BUNTA, CAROLINA (LMFT)
Entity Type:Individual
Prefix:MS
First Name:CAROLINA
Middle Name:
Last Name:BUNTA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2911 DIXWELL AVE STE B-11
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3152
Mailing Address - Country:US
Mailing Address - Phone:203-892-4215
Mailing Address - Fax:
Practice Address - Street 1:400 COLUMBUS AVE
Practice Address - Street 2:APC
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1233
Practice Address - Country:US
Practice Address - Phone:203-503-3075
Practice Address - Fax:203-503-3296
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2120106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004235918Medicaid