Provider Demographics
NPI:1578909024
Name:DEMUNBRUN, DONNA GENEVA (LCSW)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:GENEVA
Last Name:DEMUNBRUN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 FINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-4378
Mailing Address - Country:US
Mailing Address - Phone:317-220-8098
Mailing Address - Fax:
Practice Address - Street 1:1209 FINLEY AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46203-4378
Practice Address - Country:US
Practice Address - Phone:317-220-8098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000657A171M00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator